Provider Demographics
NPI:1700444999
Name:SONI, NICOLE K (MA, LCPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:SONI
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEMBURY WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6153
Mailing Address - Country:US
Mailing Address - Phone:224-256-2250
Mailing Address - Fax:224-256-2615
Practice Address - Street 1:3660 N LAKE SHORE DR STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5302
Practice Address - Country:US
Practice Address - Phone:773-759-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional