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General NPI Number Information
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NPI Number | 1275257115
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Entity Type | Individual
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Provider Name | CAROLYN RUDOLF M.A., NCSP
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 435 NORTH ST
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City | CRETE
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State | IL
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Zip | 60417-2258
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Country | US
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Telephone | 708-367-8477
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Fax |
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Provider Business Mailing Address
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Address Line | 8 BROOKSIDE RD
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City | PARK FOREST
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State | IL
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Zip | 60466-2505
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Country | US
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Telephone | 708-268-8472
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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