Healthcare Provider Details

I. General information

NPI: 1063337921
Provider Name (Legal Business Name): LINDSAY MICKELSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N CLARK ST STE 212
CHICAGO IL
60614-1850
US

IV. Provider business mailing address

2502 N CLARK ST STE 212
CHICAGO IL
60614-1850
US

V. Phone/Fax

Practice location:
  • Phone: 773-930-9553
  • Fax:
Mailing address:
  • Phone: 773-930-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7947125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: