Provider Demographics
NPI:1114636313
Name:CHOKLAD, LINDSEY ROSE (MSW, CADC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ROSE
Last Name:CHOKLAD
Suffix:
Gender:F
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 WESTPORT RDG
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8991
Mailing Address - Country:US
Mailing Address - Phone:815-404-8493
Mailing Address - Fax:
Practice Address - Street 1:422 TRACY CT
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6288
Practice Address - Country:US
Practice Address - Phone:888-928-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty