Individual
DIANE NICKLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11114 KAREN DR, ORLAND PARK, IL 60467-4482
(773) 791-9884
Mailing address
11114 KAREN DR, ORLAND PARK, IL 60467-4482
(773) 791-9884
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149013771
IL
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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