Provider Demographics
NPI:1508514894
Name:POLLUM, STEPHEN KALEB (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KALEB
Last Name:POLLUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:KALEB
Other - Middle Name:
Other - Last Name:POLLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2687 LITTLE TEXAS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IL
Mailing Address - Zip Code:61931-8046
Mailing Address - Country:US
Mailing Address - Phone:217-273-8829
Mailing Address - Fax:
Practice Address - Street 1:111 LIONS DR STE 210
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3175
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:877-428-7891
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106832104100000X
IL149.0269841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker