Provider Demographics
NPI:1134660566
Name:COUGHLIN, BARBARA WYNN (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:WYNN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WASHINGTON BLVD
Mailing Address - Street 2:APT 3B
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4123
Mailing Address - Country:US
Mailing Address - Phone:224-532-6814
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST
Practice Address - Street 2:STE 603A
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:224-532-6814
Practice Address - Fax:312-578-9004
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32989101YA0400X
1041C0700X
IL1490191581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)