Provider Demographics
NPI:1114119492
Name:POLLERT, KEVIN DUANE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DUANE
Last Name:POLLERT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-6211
Mailing Address - Country:US
Mailing Address - Phone:317-988-4843
Mailing Address - Fax:317-988-1854
Practice Address - Street 1:2669 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-6211
Practice Address - Country:US
Practice Address - Phone:317-988-4843
Practice Address - Fax:317-988-1854
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006077A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical