Provider Demographics
NPI:1912969122
Name:HUMBLE, CAROL J (MS ATC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W 466 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6425
Mailing Address - Country:US
Mailing Address - Phone:630-469-6089
Mailing Address - Fax:
Practice Address - Street 1:21 W 466 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6425
Practice Address - Country:US
Practice Address - Phone:630-469-6089
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer