Provider Demographics
NPI:1891208419
Name:COFFIN, COLTEN DEAN (MA, LCSW)
Entity Type:Individual
Prefix:MR
First Name:COLTEN
Middle Name:DEAN
Last Name:COFFIN
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 W ARGYLE ST # 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3610
Mailing Address - Country:US
Mailing Address - Phone:312-213-4871
Mailing Address - Fax:
Practice Address - Street 1:12145 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1387
Practice Address - Country:US
Practice Address - Phone:773-537-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102660104100000X
IL1490211341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker