Provider Demographics
NPI:1417915869
Name:NICKEL, JULIA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:JO
Last Name:NICKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60431-5315
Mailing Address - Country:US
Mailing Address - Phone:815-545-3348
Mailing Address - Fax:
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-545-3348
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL15389791041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical