Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Southern Illinois University Carbondale Clinical Center

Organization Psychologist · NPI 1174919351

Southern Illinois University Carbondale Clinical Center is a Psychologist in Carbondale, Illinois. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
4
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Practice location Address checks out

625 Wham Dr Rm 141
Carbondale, IL 62901
Phone: (618) 453-2361
Fax: (618) 453-6130
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X
Counseling Psychologist Taxonomy 103TC1900X
Clinical Social Worker Taxonomy 1041C0700X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1174919351
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationSouthern Illinois University Carbondale
Authorized official Holly Cormier — Director · (618) 453-2361
NPI enumeratedApril 14, 2015
Last updated in NPPESApril 14, 2015
Mailing address625 Wham Drive Room 141, Carbondale, IL 62901

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