Provider Demographics
NPI:1366786113
Name:JESSICA NIKKILA, LCSW, LLC
Entity type:Organization
Organization Name:JESSICA NIKKILA, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKKILA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-343-4204
Mailing Address - Street 1:3533 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1112
Mailing Address - Country:US
Mailing Address - Phone:773-343-4204
Mailing Address - Fax:
Practice Address - Street 1:3533 MORTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1112
Practice Address - Country:US
Practice Address - Phone:773-343-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-18
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490124281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty