=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811448483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRIE BRADEAN, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2016
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 CHURCH ST STE 415
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-440-4285
-----------------------------------------------------
Fax | 847-787-1836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 636 CHURCH ST STE 415
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-440-4285
-----------------------------------------------------
Fax | 847-787-1836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CARRIE GRACE BRADEAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 847-440-4285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------