Provider Demographics
NPI:1366819526
Name:PASCIAK, COLLEEN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:PASCIAK
Suffix:
Gender:F
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 1:547 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2478
Mailing Address - Country:US
Mailing Address - Phone:847-707-2798
Mailing Address - Fax:
Practice Address - Street 1:1113 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-367-5991
Practice Address - Fax:847-367-5997
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0204821041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical