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NPI Code Detail

MEDICARE: MS. MICHELE M CARROLL L.C.S.W.

MEDICARE: MS. MICHELE M CARROLL L.C.S.W.
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
11041C0700XClinical Social Worker149013691IL

General Provider Information

NPI Number : 1588008122
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELE M CARROLL L.C.S.W.
Provider Business Mailing Address
First Line : 902 W OLIVE ST
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61701-4963
Country : US
Telephone Number : 309-287-5381
Fax Number :
Provider Business Practice Location Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 309-706-3190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2013
Last Update Date : 03/20/2026

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