MEDICARE: MRS. JESSICA NIKKILA LCSW

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	149012428	IL

General Provider Information

NPI Number	:	1124331954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA NIKKILA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 492
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-0492
Country	:	US
Telephone Number	:	773-343-4204
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 MORTON AVE
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1112
Country	:	US
Telephone Number	:	773-343-4204
Fax Number	:

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

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	01/27/2022

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