Healthcare Provider Details

I. General information

NPI: 1972433787
Provider Name (Legal Business Name): CARLY COWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SKOKIE BLVD STE 503
NORTHBROOK IL
60062-7913
US

IV. Provider business mailing address

450 SKOKIE BLVD STE 503
NORTHBROOK IL
60062-7913
US

V. Phone/Fax

Practice location:
  • Phone: 847-238-2533
  • Fax:
Mailing address:
  • Phone: 847-238-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150103284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: