Provider Demographics
NPI:1851553812
Name:VOLLRATH, CAROL A (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:VOLLRATH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S BUTTERNUT CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2125
Mailing Address - Country:US
Mailing Address - Phone:815-469-3408
Mailing Address - Fax:
Practice Address - Street 1:1004 S BUTTERNUT CIR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2125
Practice Address - Country:US
Practice Address - Phone:815-469-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006766101YM0800X
IL166.000667106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist