Provider Demographics
NPI:1558024125
Name:KOLLEREB, KATEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATEY
Middle Name:
Last Name:KOLLEREB
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 1:12934 SUMMER HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1399
Mailing Address - Country:US
Mailing Address - Phone:630-842-4393
Mailing Address - Fax:
Practice Address - Street 1:123 W WASHINGTON ST STE 321
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8297
Practice Address - Country:US
Practice Address - Phone:630-383-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490175251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical