MEDICARE: RENEE KLYCZEK NORDSTROM LCPC, ATR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.010311	IL

General Provider Information

NPI Number	:	1932652963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE KLYCZEK NORDSTROM LCPC, ATR

Provider Business Mailing Address
First Line	:	1527 OTTO BLVD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3442
Country	:	US
Telephone Number	:	708-212-0137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 OTTO BLVD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3442
Country	:	US
Telephone Number	:	708-212-0137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/21/2022

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