Healthcare Provider Details

I. General information

NPI: 1235694233
Provider Name (Legal Business Name): CARLEY DOLENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N MILWAUKEE AVE STE 101
LIBERTYVILLE IL
60048-1359
US

IV. Provider business mailing address

1585 N MILWAUKEE AVE STE 101
LIBERTYVILLE IL
60048-1359
US

V. Phone/Fax

Practice location:
  • Phone: 847-918-7947
  • Fax:
Mailing address:
  • Phone: 847-910-7947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152000324
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-68248
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: