Healthcare Provider Details

I. General information

NPI: 1952317588
Provider Name (Legal Business Name): CAROLYN I WERNEKE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ILLINOIS AVE SUITE 1-A
ST CHARLES IL
60174-2966
US

IV. Provider business mailing address

601 CHESAPEAKE RD
ST CHARLES IL
60175-5632
US

V. Phone/Fax

Practice location:
  • Phone: 630-421-7260
  • Fax: 630-513-0919
Mailing address:
  • Phone: 630-421-7260
  • Fax: 630-513-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1395103
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: