Provider Demographics
NPI:1073077335
Name:WOLCOTT, BRADLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FOX CHASE DR N
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8889
Mailing Address - Country:US
Mailing Address - Phone:630-772-7783
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 101N
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3405
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:630-586-9990
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19145941041S0200X
IL1490116151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool