Provider Demographics
NPI:1497967830
Name:ILVONEN, CAROL BUNNELL (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:BUNNELL
Last Name:ILVONEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3216
Mailing Address - Country:US
Mailing Address - Phone:303-777-1079
Mailing Address - Fax:
Practice Address - Street 1:455 S HUDSON ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1479
Practice Address - Country:US
Practice Address - Phone:303-649-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8764581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6248-6Medicare ID - Type Unspecified