Healthcare Provider Details

I. General information

NPI: 1831052489
Provider Name (Legal Business Name): CARLY WICKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST FL 3
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

3325 W CARROLL AVE APT 2
CHICAGO IL
60624-2035
US

V. Phone/Fax

Practice location:
  • Phone: 773-565-2550
  • Fax:
Mailing address:
  • Phone: 773-542-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: