Provider Demographics
NPI:1508284258
Name:NICHOLS, ALLISON R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:R
Last Name:NICHOLS
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 1:676 N SAINT CLAIR ST STE 2030
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2830
Mailing Address - Country:US
Mailing Address - Phone:312-926-6831
Mailing Address - Fax:312-926-2200
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2030
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2830
Practice Address - Country:US
Practice Address - Phone:312-926-6831
Practice Address - Fax:312-926-2200
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0165381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216521Medicare PIN