Provider Demographics
NPI:1558695692
Name:KALOUPEK, HEATHER MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:KALOUPEK
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 1:106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1207
Mailing Address - Country:US
Mailing Address - Phone:217-330-6282
Mailing Address - Fax:217-481-8701
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1207
Practice Address - Country:US
Practice Address - Phone:217-330-6282
Practice Address - Fax:217-481-8701
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0157521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.015752OtherILLINOIS DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION