Provider Demographics
NPI:1073827028
Name:CHICOSKI, JEFFREY NOLAN (LMSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NOLAN
Last Name:CHICOSKI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 HOLIDAY TER
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2196
Mailing Address - Country:US
Mailing Address - Phone:269-372-4140
Mailing Address - Fax:269-372-0390
Practice Address - Street 1:526 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5306
Practice Address - Country:US
Practice Address - Phone:269-303-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical