Provider Demographics
NPI:1316020282
Name:CHICKERNEO, NANCY B (PH D LCPC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:B
Last Name:CHICKERNEO
Suffix:
Gender:F
Credentials:PH D LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39W040 HOGAN HL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8472
Mailing Address - Country:US
Mailing Address - Phone:630-965-8778
Mailing Address - Fax:630-965-8778
Practice Address - Street 1:39W040 HOGAN HL
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-8472
Practice Address - Country:US
Practice Address - Phone:630-965-8778
Practice Address - Fax:630-965-8778
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health