Provider Demographics
NPI:1336938984
Name:ENGELHARDT, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:ENGELHARDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9498
Mailing Address - Country:US
Mailing Address - Phone:224-531-8054
Mailing Address - Fax:
Practice Address - Street 1:475 W TERRA COTTA AVE STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3407
Practice Address - Country:US
Practice Address - Phone:815-707-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health