Provider Demographics
NPI:1073788006
Name:NIKITINA, YELENA D (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:YELENA
Middle Name:D
Last Name:NIKITINA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 W HOWARD ST
Mailing Address - Street 2:3FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1675
Mailing Address - Country:US
Mailing Address - Phone:312-744-7617
Mailing Address - Fax:312-744-1621
Practice Address - Street 1:1607 W HOWARD ST
Practice Address - Street 2:3FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1675
Practice Address - Country:US
Practice Address - Phone:312-744-7617
Practice Address - Fax:312-744-1621
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002-0077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker