Healthcare Provider Details

I. General information

NPI: 1245394345
Provider Name (Legal Business Name): CAROL LEE SCHICKEL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W ADDISON ST
CHICAGO IL
60613-3819
US

IV. Provider business mailing address

1441 S PLYMOUTH CT UNIT G
CHICAGO IL
60605-3364
US

V. Phone/Fax

Practice location:
  • Phone: 312-909-9337
  • Fax:
Mailing address:
  • Phone: 312-909-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: