MEDICARE: REGINA CARLSON LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180014478	IL

General Provider Information

NPI Number	:	1144971045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA CARLSON LCPC

Provider Business Mailing Address
First Line	:	5106 PONTIGO GLEN DR # SR
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-4028
Country	:	US
Telephone Number	:	630-362-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 N HAMMES AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-8113
Country	:	US
Telephone Number	:	815-290-0902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	06/08/2026

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