Provider Demographics
NPI:1801495460
Name:CZOLGOSZ, CHLOE J (MA, LMHC)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:J
Last Name:CZOLGOSZ
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3730
Mailing Address - Country:US
Mailing Address - Phone:309-883-4475
Mailing Address - Fax:
Practice Address - Street 1:3308 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3730
Practice Address - Country:US
Practice Address - Phone:309-883-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126312101YM0800X
IN39004460A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health