Provider Demographics
NPI:1023046091
Name:TRELOAR, KEVIN REGINALD (MSW LCSW DCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:REGINALD
Last Name:TRELOAR
Suffix:
Gender:M
Credentials:MSW LCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1420
Mailing Address - Country:US
Mailing Address - Phone:618-741-4024
Mailing Address - Fax:618-659-9173
Practice Address - Street 1:1046 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1420
Practice Address - Country:US
Practice Address - Phone:618-741-4024
Practice Address - Fax:618-741-4024
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490096541041C0700X
MO20030170291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209604Medicare ID - Type Unspecified
MO000081704Medicare UPIN