Provider Demographics
NPI:1275066094
Name:KLICKER-NICKLAY, ELIZABETH A (LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KLICKER-NICKLAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 N SHERIDAN RD APT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2031
Mailing Address - Country:US
Mailing Address - Phone:773-236-7563
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1471
Practice Address - Country:US
Practice Address - Phone:773-236-7563
Practice Address - Fax:224-985-2119
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional