Healthcare Provider Details

I. General information

NPI: 1992164545
Provider Name (Legal Business Name): CAITLIN OTWELL MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 N JANSSEN AVE APT 1
CHICAGO IL
60613-2800
US

IV. Provider business mailing address

3841 N JANSSEN AVE APT 1
CHICAGO IL
60613-2800
US

V. Phone/Fax

Practice location:
  • Phone: 312-925-8437
  • Fax:
Mailing address:
  • Phone: 312-925-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008966
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: