MEDICARE: JESSICA NIKKILA, LCSW, LLC

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	:	1366786113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA NIKKILA, LCSW, LLC

Provider Business Mailing Address
First Line	:	3533 MORTON AVE
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1112
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	:	CLINICAL SOCIAL WORKER
Name	:	MISS JESSICA NIKKILA
Credential	:	LCSW
Telephone Number	:	773-343-4204

Provider Enumeration Date	:	11/18/2012
Last Update Date	:	02/08/2022

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