Individual provider Active NPI

Elizabeth A Klicker-Nicklay, LCPC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1275066094
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180010949 Issued in IL
Practice address
4707 N Broadway St Ste 205
Chicago, IL 60640-4963
Phone
(773) 236-7563
NPI assigned
Apr 8, 2017
Last updated
Apr 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180010949 IL Primary

Addresses

Primary practice location

4707 N Broadway St Ste 205
Chicago, IL 60640-4963

Mailing address

4707 N Broadway St Ste 205
Chicago, IL 60640-4963
Phone (773) 236-7563

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250325003652 IL Practitioner - Mental Health Counselor 8921521444 Reassigns benefits to 1 organization
Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Group practices
The Juniper Center PCGroup PAC ID 1557557725, 26 clinicians

Practice addresses (Care Compare)

1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1471
Phone (847) 778-4533

4707 N Broadway St
Suite 205
Chicago, IL 60640-4963
Phone (773) 236-7563

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180010949ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Ekn LCPC PLLC Professional Current Accepting new patients

Locations

4707 N Broadway St
Ste 205
Chicago, IL 60640
Phone (773) 236-7563

410 S Michigan Ave
Ste 943
Chicago, IL 60605
Phone (773) 732-7700

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1275066094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 N BROADWAY ST STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404963",
            "telephone_number": "773-236-7563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 N BROADWAY ST STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404963",
            "telephone_number": "773-236-7563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLICKER-NICKLAY",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-08",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180010949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.