Provider Demographics
NPI:1699009019
Name:KLINKERT, CAROLYN (LCPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KLINKERT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WILLOWS EDGE CT
Mailing Address - Street 2:UNIT D
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1261
Mailing Address - Country:US
Mailing Address - Phone:708-969-2220
Mailing Address - Fax:
Practice Address - Street 1:111 N COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3977
Practice Address - Country:US
Practice Address - Phone:630-221-4677
Practice Address - Fax:630-510-5469
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health