Healthcare Provider Details

I. General information

NPI: 1023942430
Provider Name (Legal Business Name): CAROLYN ANN HICKOK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CANAL ST UNIT 1104
CHICAGO IL
60606-4907
US

IV. Provider business mailing address

350 N CANAL ST UNIT 1104
CHICAGO IL
60606-4907
US

V. Phone/Fax

Practice location:
  • Phone: 815-210-6724
  • Fax:
Mailing address:
  • Phone: 815-210-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020.013293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: