MEDICARE: CLICC LLC

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1700729860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLICC LLC

Provider Business Mailing Address
First Line	:	30 N GOULD ST STE R
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	773-379-5670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 W WRIGHTWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1137
Country	:	US
Telephone Number	:	773-379-5670
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, HEAD OF COACHING
Name	:	HANNAH JUDSON
Credential	:	NBC-HWC, MA
Telephone Number	:	773-379-5670

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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