Provider Demographics
NPI:1992164545
Name:OTWELL, CAITLIN (MA, LCPC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:OTWELL
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 N JANSSEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2800
Mailing Address - Country:US
Mailing Address - Phone:312-925-8437
Mailing Address - Fax:
Practice Address - Street 1:3841 N JANSSEN AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2800
Practice Address - Country:US
Practice Address - Phone:312-925-8437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional