Provider Demographics
NPI:1902781982
Name:BURNSIDE, NICOLE PAIGE (LCSW, CWEL)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:PAIGE
Last Name:BURNSIDE
Suffix:
Gender:F
Credentials:LCSW, CWEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4109
Mailing Address - Country:US
Mailing Address - Phone:847-242-1126
Mailing Address - Fax:
Practice Address - Street 1:701 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4109
Practice Address - Country:US
Practice Address - Phone:847-242-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0298571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical