Active NPI
Renee Klyczek Nordstrom, LCPC, ATR
- Professional Counselor
- Chicago Heights, IL
National Provider Identifier
1932652963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.010311
- Practice address
- 1527 Otto Blvd
Chicago Heights, IL 60411-3442 - Phone
- (708) 212-0137
- NPI assigned
- Jul 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.010311 | IL | Primary |
Addresses
Primary practice location
1527 Otto Blvd
Chicago Heights, IL 60411-3442
Mailing address
1527 Otto Blvd
Chicago Heights, IL 60411-3442
Phone (708) 212-0137
Other practice location 1
8 Heritage Plaza
Bourbannais, IL 60914
Phone (708) 365-8408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.010311 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1932652963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1527 OTTO BLVD",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604113442",
"telephone_number": "708-212-0137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1527 OTTO BLVD",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604113442",
"telephone_number": "708-212-0137"
}
],
"practiceLocations": [
{
"address_1": "8 Heritage Plaza",
"address_purpose": "LOCATION",
"city": "Bourbannais",
"state": "IL",
"postal_code": "60914",
"country_code": "US",
"telephone_number": "708-365-8408",
"fax_number": "815-928-9200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLYCZEK NORDSTROM",
"first_name": "RENEE",
"credential": "LCPC, ATR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-26",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.010311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.