Healthcare Provider Details

I. General information

NPI: 1629784004
Provider Name (Legal Business Name): LORETTA L COLHARDT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16221 W 159TH ST
LOCKPORT IL
60441-7901
US

IV. Provider business mailing address

1700 ARBOR LN APT 303B
CREST HILL IL
60403-2132
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-7890
  • Fax:
Mailing address:
  • Phone: 779-939-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149032039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: