Provider Demographics
NPI:1053934125
Name:LINCKE, CYNTHIA EVERET NICHOLA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:EVERET NICHOLA
Last Name:LINCKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N COUNTY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4315
Mailing Address - Country:US
Mailing Address - Phone:224-639-3295
Mailing Address - Fax:
Practice Address - Street 1:33 N COUNTY ST STE 202
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4315
Practice Address - Country:US
Practice Address - Phone:224-639-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103062104100000X
IL149.0239561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker