Provider Demographics
NPI:1760840961
Name:ESCHENBACH, NICOLE RENEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENEE
Last Name:ESCHENBACH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:DELACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1140 N. MCLEAN BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-695-3680
Mailing Address - Fax:224-856-2829
Practice Address - Street 1:1140 N. MCLEAN BLVD.
Practice Address - Street 2:SUITE I
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-695-3680
Practice Address - Fax:224-856-2829
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1235283441OtherAGENCY NPI