1932349917 NPI number — MS. LYNN HELEN EMMY GULLICKSON SPENCER M.A., LPC

Table of content: MS. LYNN HELEN EMMY GULLICKSON SPENCER M.A., LPC (NPI 1932349917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932349917 NPI number — MS. LYNN HELEN EMMY GULLICKSON SPENCER M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULLICKSON SPENCER
Provider First Name:
LYNN
Provider Middle Name:
HELEN EMMY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GULLICKSON
Provider Other First Name:
LYNN
Provider Other Middle Name:
HELEN EMMY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932349917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8621 NILES CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-521-6350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 S PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GLEN ELLYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60137-6280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-984-4896
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  178004921 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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