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General NPI Number Information
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NPI Number | 1194676981
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Entity Type | Individual
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Provider Name | ERIN LYNN RANDOLPH LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 657 ROLLINGWOOD PL
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City | VARNA
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State | IL
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Zip | 61375-9545
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Country | US
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Telephone | 630-687-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 657 ROLLINGWOOD PL PO BOX 71
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City | VARNA
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State | IL
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Zip | 61375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149029257
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License Number State | IL
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