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NICOLE ANGELA KELLEY LCSW
NPI 1659473437
Social Worker - Clinical in Normal, IL

Active since September 02, 2006Opted out of Medicare · through Mar 29, 2027
112 BOEYKENS PL, SUITE 4A, NORMAL, IL 61761(309) 242-7925(309) 454-9521 Get Directions Write a Review

NPPES record last updated: March 30, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 30, 2017, Dec 9, 2015 (2 updates tracked since 2015).

About Nicole Angela Kelley Lcsw NPPES

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

NICOLE ANGELA KELLEY LCSW (NPI 1659473437) is an individual clinical provider in Normal, Illinois, licensed in Illinois (149011400) and active in the NPI registry since September 2006. She has opted out of Medicare through March 29, 2027.

NPPES Registry Identity

NPI1659473437
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameNICOLE ANGELA KELLEYCredential: LCSW
Location Address112 BOEYKENS PL, SUITE 4ANormal, IL 61761-2152
Mailing Address702 N Washington StHudson, IL 61748-9476 · (309) 242-7925
Phone(309) 242-7925
Fax(309) 454-9521
Sole ProprietorYes
Enumeration DateSeptember 2, 2006
Last NPPES UpdateMarch 30, 20172 updates tracked since enumeration
✔ NPI 1659473437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in IL · 149011400
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
112 BOEYKENS PL, Normal, IL 61761
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Nicole Angela Kelley Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 29, 2023 through March 29, 2027.

Opt-Out Effective DateMarch 29, 2023
Opt-Out In Effect ThroughMarch 29, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 5

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

MS. MARY ANN SHELTON LMBT
Massage Therapist
112 BOEYKENS PL, SUITE 3E
NORMAL, IL 61761
McLean County (309) 310-9730
OLGA TREMUD ST
112 BOEYKENS PL, STE. 2A
NORMAL, IL 61761
McLean County (309) 846-4716
TYSON NEWSON ST
112 BOEYKENS PL, SUITE 2A
NORMAL, IL 61761
McLean County (309) 846-4716
MS. JENNIFER LYNN HAMILTON M.S. LCPC
Counselor
112 BOEYKENS PL, SUITE 4A
NORMAL, IL 61761
McLean County (309) 830-4553
COLLEEN DWYER
112 BOEYKENS PL, SUITE 2A
NORMAL, IL 61761
McLean County (309) 846-4716

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 Nicole Kelley's NPI number?

The NPI number for Nicole Kelley is 1659473437. It was assigned to this individual provider in the NPPES registry on September 2, 2006.

Where is Nicole Kelley located?

Nicole Kelley practices at 112 Boeykens Pl Suite 4A, Normal, IL 61761. The listed phone number is (309) 242-7925.

What is Nicole Kelley's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Nicole Kelley enrolled in Medicare?

No. Nicole Kelley has opted out of Medicare through March 29, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Nicole Kelley was last updated on March 30, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.