Healthcare Provider Details

I. General information

NPI: 1851201123
Provider Name (Legal Business Name): KATELYN NYQUIST LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JORIE BLVD STE 36
OAK BROOK IL
60523-4501
US

IV. Provider business mailing address

22W231 SUNNYSIDE RD
MEDINAH IL
60157-9705
US

V. Phone/Fax

Practice location:
  • Phone: 312-350-5159
  • Fax:
Mailing address:
  • Phone: 312-350-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.033309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: