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General NPI Number Information
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NPI Number | 1477708030
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Entity Type | Individual
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Provider Name | ANN CARLSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD SUITE 112
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City | OAK BROOK
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State | IL
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Zip | 60523-2215
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Country | US
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Telephone | 630-275-6200
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Fax | 630-963-8745
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Provider Business Mailing Address
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Address Line | 4912 STANLEY AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3707
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Country | US
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Telephone | 630-209-4625
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Fax | 630-963-8745
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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 | 149006953
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License Number State | IL
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