Healthcare Provider Details

I. General information

NPI: 1124984083
Provider Name (Legal Business Name): CAROLYN STREADWICK MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 N SHADY OAKS DR
ELGIN IL
60120-4380
US

IV. Provider business mailing address

872 N SHADY OAKS DR
ELGIN IL
60120-4380
US

V. Phone/Fax

Practice location:
  • Phone: 331-431-8676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150.118794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: