Provider Demographics
NPI:1588218622
Name:KOLKEY, SAMANTHA VALENTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:VALENTINE
Last Name:KOLKEY
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 1:961 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4273
Mailing Address - Country:US
Mailing Address - Phone:847-404-7264
Mailing Address - Fax:
Practice Address - Street 1:1601 SHERMAN AVE STE 510
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5047
Practice Address - Country:US
Practice Address - Phone:312-800-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0200621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical