Provider Demographics
NPI:1992910145
Name:ECKERT, CAROLYN
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:ECKERT
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 1:1041 N MILL ST APT 203
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2538
Mailing Address - Country:US
Mailing Address - Phone:630-428-8197
Mailing Address - Fax:
Practice Address - Street 1:2801 FINLEY RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1038
Practice Address - Country:US
Practice Address - Phone:630-628-5176
Practice Address - Fax:630-628-2350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist