Healthcare Provider Details

I. General information

NPI: 1376215756
Provider Name (Legal Business Name): NICOLE SKINNION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2269 N KEDZIE BLVD APT 1
CHICAGO IL
60647-2591
US

IV. Provider business mailing address

2269 N KEDZIE BLVD APT 1
CHICAGO IL
60647-2591
US

V. Phone/Fax

Practice location:
  • Phone: 312-819-7381
  • Fax: 312-819-3093
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: