Provider Demographics
NPI:1952293375
Name:KNICKERBOCKER, MORGAN (M A, LCP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:KNICKERBOCKER
Suffix:
Gender:F
Credentials:M A, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2548
Mailing Address - Country:US
Mailing Address - Phone:224-545-6177
Mailing Address - Fax:
Practice Address - Street 1:129 W VALLETTE ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4419
Practice Address - Country:US
Practice Address - Phone:844-984-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional