Provider Demographics
NPI:1194475871
Name:CARPENTER, KLAUDIA M
Entity type:Individual
Prefix:
First Name:KLAUDIA
Middle Name:M
Last Name:CARPENTER
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 1:21141 GOVERNORS HWY, STE 114 PMB 1033
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3818
Mailing Address - Country:US
Mailing Address - Phone:708-646-3107
Mailing Address - Fax:
Practice Address - Street 1:21126 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2530
Practice Address - Country:US
Practice Address - Phone:708-646-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014349101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor