Provider Demographics
NPI:1770214835
Name:HESSELBAUM, KELLY WINKELBAUER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:WINKELBAUER
Last Name:HESSELBAUM
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 1:501 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3385
Mailing Address - Country:US
Mailing Address - Phone:330-388-5839
Mailing Address - Fax:
Practice Address - Street 1:76 S MAIN ST # A
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5070
Practice Address - Country:US
Practice Address - Phone:630-466-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical