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DR. MAUREEN TARA NICKERSON PSYD
NPI 1578130274
Psychologist - Clinical in Medical Lake, WA

Active since June 10, 2021PECOS Enrolled
850 W. MAPLE ST., MEDICAL LAKE, WA 99022(509) 565-4000 Get Directions Write a Review

NPPES record last updated: June 10, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Maureen Tara Nickerson Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MAUREEN TARA NICKERSON PSYD (NPI 1578130274) is an individual clinical provider in Medical Lake, Washington, licensed in Washington (PY60778414) and active in the NPI registry since June 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1578130274
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. MAUREEN TARA NICKERSONCredential: PSYD
Location Address850 W. MAPLE ST.Medical Lake, WA 99022
Mailing AddressP.o. Box 800, 850 W. Maple St.Medical Lake, WA 99022
Phone(509) 565-4000
Sole ProprietorNo
Enumeration DateJune 10, 2021
NPPES CertifiedJune 10, 2021
✔ NPI 1578130274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in WA · PY60778414
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
850 W. MAPLE ST., Medical Lake, WA 99022
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Maureen Tara Nickerson Psyd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Maureen Nickerson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Department Of Social Dept Of Shs Div Of Instns
Same address
Psychiatric Hospital
850 MAPLE ST
Medical Lake, WA 99022
  • Reassigned Medicare billing, Washington enrollment
  • 57 clinicians in this Medicare group
NPI 1467440602 (509) 565-4000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 99022 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$172.80 typical visit price
range $57.27 – $172.80
Typical copayment $43.20 (range $14.31 – $43.20)
Most-billed visit code 99205
Established Patient
$100.78 typical visit price
range $18.56 – $141.11
Typical copayment $25.19 (range $4.64 – $35.27)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISA MATHEWS
Psychologist
850 W. MAPLE ST.
MEDICAL LAKE, WA 99022
Spokane County (509) 565-4000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maureen Nickerson's NPI number?

The NPI number for Maureen Nickerson is 1578130274. It was assigned to this individual provider in the NPPES registry on June 10, 2021.

Where is Maureen Nickerson located?

Maureen Nickerson practices at 850 W. Maple St., Medical Lake, WA 99022. The listed phone number is (509) 565-4000.

What is Maureen Nickerson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Maureen Nickerson enrolled in Medicare?

Yes. Maureen Nickerson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Maureen Nickerson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Maureen Nickerson reassigns Medicare benefits to Department Of Social Dept Of Shs Div Of Instns (Medical Lake, WA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Maureen Nickerson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Maureen Nickerson was last updated on June 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.