MEDICARE: JEFFREY NOLAN CHICOSKI LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801090171	MI

General Provider Information

NPI Number	:	1073827028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY NOLAN CHICOSKI LMSW

Provider Business Mailing Address
First Line	:	5340 HOLIDAY TER
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-2196
Country	:	US
Telephone Number	:	269-372-4140
Fax Number	:	269-372-0390

Provider Business Practice Location Address
First Line	:	526 W CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5306
Country	:	US
Telephone Number	:	269-303-2299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	02/15/2024

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