Healthcare Provider Details

I. General information

NPI: 1760597439
Provider Name (Legal Business Name): JENNIFER LYNN FICKER M.S.W., L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

410 GINGER BEND DR APT. 203
CHAMPAIGN IL
61822-3567
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-3000
  • Fax: 217-554-4860
Mailing address:
  • Phone: 217-649-5169
  • Fax: 217-554-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: