Healthcare Provider Details

I. General information

NPI: 1255262689
Provider Name (Legal Business Name): STEVEN J KELLEY, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 W 7340N RD
MANTENO IL
60950-3288
US

IV. Provider business mailing address

5140 W 7340N RD
MANTENO IL
60950-3288
US

V. Phone/Fax

Practice location:
  • Phone: 708-259-2071
  • Fax:
Mailing address:
  • Phone: 708-259-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN J KELLEY
Title or Position: CLINICAL SOCIAL WORKER/FOUNDER
Credential: LCSW
Phone: 708-259-2071