Provider Demographics
NPI:1023654589
Name:THIELEN, CAROLINE MARIE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:THIELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20550 S LA GRANGE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1495
Mailing Address - Country:US
Mailing Address - Phone:708-614-6860
Mailing Address - Fax:
Practice Address - Street 1:20550 S LA GRANGE RD STE 210
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1495
Practice Address - Country:US
Practice Address - Phone:708-614-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL178.017660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional