Healthcare Provider Details

I. General information

NPI: 1306700539
Provider Name (Legal Business Name): KALAB POLKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 TEMPLE LN
ROCKFORD IL
61112-1045
US

IV. Provider business mailing address

1628 TEMPLE LN
ROCKFORD IL
61112-1045
US

V. Phone/Fax

Practice location:
  • Phone: 888-277-4028
  • Fax:
Mailing address:
  • Phone: 888-277-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number249.030459
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: