Provider Demographics
NPI:1649041393
Name:PHILLIPS, CAITLIN C (LSW)
Entity type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 EMERSON CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2635
Mailing Address - Country:US
Mailing Address - Phone:630-819-9751
Mailing Address - Fax:
Practice Address - Street 1:4550 WEST 103RD STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4868
Practice Address - Country:US
Practice Address - Phone:773-280-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150111655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker