Individual
CAROLYN TILLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
317 W COLFAX ST, SUITE 111, PALATINE, IL 60067-2535
(847) 507-3352
Mailing address
57 S PRAIRIE ST, CARY, IL 60013-2614
(847) 507-3352
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-001630
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0162-6486
BC/BS PROVIDER #
IL
01
—
115 392 13
CAQH
IL
01
—
149-001630
LIC.CLINICAL SOC. WKR.
IL
Enumeration date
07/16/2006
Last updated
02/24/2014
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