Provider Demographics
NPI:1285846238
Name:KHAN, CAROLYN S (LCPC, CDVP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
Credentials:LCPC, CDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 GINGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7422
Mailing Address - Country:US
Mailing Address - Phone:630-236-0206
Mailing Address - Fax:815-838-2692
Practice Address - Street 1:215 W ROMEO RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1521
Practice Address - Country:US
Practice Address - Phone:815-838-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000459170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS