Provider Demographics
NPI:1285224600
Name:COMPANY, CAROLYN K (MA, MSED)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:K
Last Name:COMPANY
Suffix:
Gender:F
Credentials:MA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HEDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7742
Mailing Address - Country:US
Mailing Address - Phone:217-430-6020
Mailing Address - Fax:
Practice Address - Street 1:322 SUSAN DRIVE SUITE C-1
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-7742
Practice Address - Country:US
Practice Address - Phone:217-430-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016665101YP2500X
IL180.015447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional