Healthcare Provider Details

I. General information

NPI: 1851513584
Provider Name (Legal Business Name): PENNY LAURA CALDWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E 79TH ST
CHICAGO IL
60619-2302
US

IV. Provider business mailing address

1658 FOLTZ DR
HOFFMAN ESTATES IL
60195-2956
US

V. Phone/Fax

Practice location:
  • Phone: 773-487-0515
  • Fax:
Mailing address:
  • Phone: 847-971-5986
  • Fax: 847-310-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: