Provider Demographics
NPI:1932349917
Name:GULLICKSON SPENCER, LYNN HELEN EMMY (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:HELEN EMMY
Last Name:GULLICKSON SPENCER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:HELEN EMMY
Other - Last Name:GULLICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8621 NILES CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2320
Mailing Address - Country:US
Mailing Address - Phone:847-521-6350
Mailing Address - Fax:
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-984-4896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178004921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional