Individual
NICOLE JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1860 W WINCHESTER RD STE 106, LIBERTYVILLE, IL 60048-5312
(262) 496-5863
Mailing address
2002 16TH AVE, KENOSHA, WI 53140-4711
(262) 496-5863
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
115845
IL
2084P0800X
Psychiatry Physician
Primary
115845
IL
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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