Provider Demographics
NPI:1578612941
Name:NICHOLS, JAYE ROSSELLA (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:JAYE
Middle Name:ROSSELLA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 WILD CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6416
Mailing Address - Country:US
Mailing Address - Phone:630-907-1456
Mailing Address - Fax:630-907-1545
Practice Address - Street 1:445 W JACKSON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5256
Practice Address - Country:US
Practice Address - Phone:630-479-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical