Healthcare Provider Details

I. General information

NPI: 1699650309
Provider Name (Legal Business Name): NICOLE ROSE PALMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST 304
ADDISON IL
60101-2586
US

IV. Provider business mailing address

2046 N SAINT LOUIS AVE # 1N
CHICAGO IL
60647-8286
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-1650
  • Fax:
Mailing address:
  • Phone: 630-303-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029592
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: