Healthcare Provider Details

I. General information

NPI: 1326795881
Provider Name (Legal Business Name): NICOLETTE ASHLEY AVERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N YORK ST STE 222
ELMHURST IL
60126-2716
US

IV. Provider business mailing address

242 N YORK ST STE 222
ELMHURST IL
60126-2716
US

V. Phone/Fax

Practice location:
  • Phone: 630-379-2689
  • Fax:
Mailing address:
  • Phone: 630-379-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150105722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: