Provider Demographics
NPI:1093828824
Name:ATKINSON, CAROLYN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5204
Mailing Address - Country:US
Mailing Address - Phone:847-433-7367
Mailing Address - Fax:630-305-7720
Practice Address - Street 1:43 E JEFFERSON AVE STE 205
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8411
Practice Address - Country:US
Practice Address - Phone:630-355-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-2038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical