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General NPI Number Information
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NPI Number | 1629790761
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Entity Type | Individual
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Provider Name | CARLIANN PENTZ
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Gender | Female
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 540 MICHIGAN AVE
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City | EVANSTON
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State | IL
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Zip | 60202-3037
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Country | US
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Telephone | 815-529-3665
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Fax |
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Provider Business Mailing Address
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Address Line | 540 MICHIGAN AVE APT H3
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City | EVANSTON
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State | IL
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Zip | 60202-3037
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Country | US
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Telephone | 815-529-3665
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150109067
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149025072
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License Number State | IL
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