Provider Demographics
NPI:1225354574
Name:COTTINGHAM EDGERTON, CARY ANN (LSW)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:ANN
Last Name:COTTINGHAM EDGERTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 W BOUGHTON RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5700
Mailing Address - Country:US
Mailing Address - Phone:630-771-0144
Mailing Address - Fax:630-771-9520
Practice Address - Street 1:682 W BOUGHTON RD
Practice Address - Street 2:UNIT D
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5700
Practice Address - Country:US
Practice Address - Phone:630-771-0144
Practice Address - Fax:630-771-9520
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker