Provider Demographics
NPI:1952317588
Name:WERNEKE, CAROLYN I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:I
Last Name:WERNEKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHESAPEAKE RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5632
Mailing Address - Country:US
Mailing Address - Phone:630-421-7260
Mailing Address - Fax:630-513-0919
Practice Address - Street 1:409 ILLINOIS AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2966
Practice Address - Country:US
Practice Address - Phone:630-421-7260
Practice Address - Fax:630-513-0919
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1395103103TS0200X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04523149OtherBLUE CROSS BLUE SHIELD