Healthcare Provider Details

I. General information

NPI: 1912363672
Provider Name (Legal Business Name): CARRIE ELIZABETH OHL L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 RIDGELAND AVE
BERWYN IL
60402-2725
US

IV. Provider business mailing address

3436 N HOYNE AVE APT #1
CHICAGO IL
60618-6147
US

V. Phone/Fax

Practice location:
  • Phone: 708-317-5926
  • Fax: 708-637-4316
Mailing address:
  • Phone: 630-853-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61516
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: