Provider Demographics
NPI:1033435557
Name:NICHOLSON, JESSICA M (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:AZOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-2940
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 404
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7216
Practice Address - Country:US
Practice Address - Phone:708-684-3980
Practice Address - Fax:708-684-3980
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1313422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry