Provider Demographics
NPI:1780701987
Name:NICOL, JASON (MS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NICOL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 EXECUTIVE PL STE 501
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2482
Mailing Address - Country:US
Mailing Address - Phone:630-232-7457
Mailing Address - Fax:630-232-7567
Practice Address - Street 1:1250 EXECUTIVE PL STE 501
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2482
Practice Address - Country:US
Practice Address - Phone:630-232-7457
Practice Address - Fax:630-232-7567
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist