Provider Demographics
NPI:1619333291
Name:ADVOCATE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:ADVOCATE CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CGC
Authorized Official - Phone:708-684-4561
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:ROOM 0019H
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-4561
Mailing Address - Fax:708-684-4763
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:ROOM 0019H
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-4561
Practice Address - Fax:708-684-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247000065282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren