Provider Demographics
NPI:1215227871
Name:VANGELDER, KARON COLES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARON
Middle Name:COLES
Last Name:VANGELDER
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 1:2790 AMLI LN
Mailing Address - Street 2:UNIT 1526
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8820
Mailing Address - Country:US
Mailing Address - Phone:630-340-4195
Mailing Address - Fax:
Practice Address - Street 1:2790 AMLI LN
Practice Address - Street 2:UNIT 1526
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-8820
Practice Address - Country:US
Practice Address - Phone:630-340-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490132471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical