Provider Demographics
NPI:1336138080
Name:STOLTZ, KAREN SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:STOLTZ
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 1:137 N OAK PARK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1344
Mailing Address - Country:US
Mailing Address - Phone:708-524-2422
Mailing Address - Fax:708-524-2796
Practice Address - Street 1:137 N OAK PARK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1344
Practice Address - Country:US
Practice Address - Phone:708-524-2422
Practice Address - Fax:708-524-2796
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0013571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204396Medicare ID - Type Unspecified