Provider Demographics
NPI:1588657316
Name:O'KLOCK, ANN K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:K
Last Name:O'KLOCK
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 1:4455 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2995
Mailing Address - Country:US
Mailing Address - Phone:563-355-2577
Mailing Address - Fax:563-355-4015
Practice Address - Street 1:4455 E 56TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:563-355-2577
Practice Address - Fax:563-355-4015
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490021211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL99089OtherBLUE CROSS IOWA NUMBER
IL0581744Medicaid
IL149002121OtherBLUE CROSS ILLINOIS NUMBE
ILIL01E1OtherJOHN DEERE PROVIDER NUMBE
ILIL01E1OtherJOHN DEERE PROVIDER NUMBE
ILK05905Medicare ID - Type UnspecifiedWPS MEDICARE NUMBER