MEDICARE: CALEB ENGELHARDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336938984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB ENGELHARDT

Provider Business Mailing Address
First Line	:	213 HILLSIDE DR
Second Line	:
City	:	ISLAND LAKE
State	:	IL
Zip	:	60042-9498
Country	:	US
Telephone Number	:	224-531-8054
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W STATE ROUTE 22 STE 100
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3416
Country	:	US
Telephone Number	:	224-662-0197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	04/16/2026

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Directions to “ CALEB ENGELHARDT ” Practice Location

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