Healthcare Provider Details

I. General information

NPI: 1811809965
Provider Name (Legal Business Name): NICOLE SUSAN BATEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N HUMBOLDT BLVD
CHICAGO IL
60647-4966
US

IV. Provider business mailing address

5403 W GIDDINGS ST
CHICAGO IL
60630-3401
US

V. Phone/Fax

Practice location:
  • Phone: 312-761-5946
  • Fax: 312-761-5946
Mailing address:
  • Phone: 312-761-5946
  • Fax: 312-761-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: