Provider Demographics
NPI:1033257332
Name:KELLOWAY, RHONDA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:K
Last Name:KELLOWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 SWIFT RD UNIT 2F
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-2403
Mailing Address - Country:US
Mailing Address - Phone:630-569-0822
Mailing Address - Fax:
Practice Address - Street 1:800 ROOSEVELT RD STE C206
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5851
Practice Address - Country:US
Practice Address - Phone:630-423-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490113711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232980OtherBLUECROSS BLUESHIELD