Provider Demographics
NPI:1164510723
Name:AHLBERG, COLETTE MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:MARIE
Last Name:AHLBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 202 - S
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-729-1388
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 202 - S
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-729-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical