Healthcare Provider Details

I. General information

NPI: 1245999119
Provider Name (Legal Business Name): HADASSAH CARLSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 JUMER DR STE A
BLOOMINGTON IL
61704-0914
US

IV. Provider business mailing address

1709 JUMER DR STE A
BLOOMINGTON IL
61704-0914
US

V. Phone/Fax

Practice location:
  • Phone: 312-890-2515
  • Fax:
Mailing address:
  • Phone: 312-890-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: