Healthcare Provider Details

I. General information

NPI: 1306420351
Provider Name (Legal Business Name): DENICE SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W LAKE ST
NORTHLAKE IL
60164-2435
US

IV. Provider business mailing address

221 30TH AVE
BELLWOOD IL
60104-1893
US

V. Phone/Fax

Practice location:
  • Phone: 855-477-5627
  • Fax:
Mailing address:
  • Phone: 810-391-8713
  • Fax: 800-549-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.004962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: