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General NPI Number Information
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NPI Number | 1578612941
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Entity Type | Individual
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Provider Name | JAYE ROSSELLA NICHOLS LCSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 445 W JACKSON AVE SUITE 107
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-479-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 2422 WILD CHERRY CT
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City | AURORA
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State | IL
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Zip | 60506-6416
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Country | US
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Telephone | 630-907-1456
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Fax | 630-907-1545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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