Healthcare Provider Details

I. General information

NPI: 1215842109
Provider Name (Legal Business Name): AMELIA KOLTHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 24TH ST
QUINCY IL
62301-4492
US

IV. Provider business mailing address

1872 HAMPSHIRE ST
QUINCY IL
62301-3146
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-0034
  • Fax: 217-592-0399
Mailing address:
  • Phone: 217-440-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: