MEDICARE: ELIZABETH A KLICKER-NICKLAY LCPC

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	180010949	IL

General Provider Information

NPI Number	:	1275066094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A KLICKER-NICKLAY LCPC

Provider Business Mailing Address
First Line	:	4707 N BROADWAY ST STE 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4963
Country	:	US
Telephone Number	:	773-236-7563
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 N BROADWAY ST STE 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4963
Country	:	US
Telephone Number	:	773-236-7563
Fax Number	:

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

Provider Enumeration Date	:	04/08/2017
Last Update Date	:	04/15/2026

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