Provider Demographics
NPI:1548705122
Name:ASWEGEN, CALLIE
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:ASWEGEN
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 1:128 S COUNTY FARM RD STE C
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2400
Mailing Address - Country:US
Mailing Address - Phone:630-447-8818
Mailing Address - Fax:630-447-8818
Practice Address - Street 1:128 S COUNTY FARM RD STE C
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2400
Practice Address - Country:US
Practice Address - Phone:630-447-8818
Practice Address - Fax:630-447-8818
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1780811569101YM0800X
IL180012330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health