Provider Demographics
NPI:1003535303
Name:POTOSKI, NICOLE C (LCPC CADC CODP I)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:POTOSKI
Suffix:
Gender:F
Credentials:LCPC CADC CODP I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 N MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1622
Mailing Address - Country:US
Mailing Address - Phone:773-283-5063
Mailing Address - Fax:
Practice Address - Street 1:250 S NORTHWEST HWY STE 110
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4237
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional