Healthcare Provider Details

I. General information

NPI: 1558024125
Provider Name (Legal Business Name): KATEY KOLLEREB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N 11TH AVE STE 106
ST CHARLES IL
60174-2278
US

IV. Provider business mailing address

12934 SUMMER HOUSE DR
PLAINFIELD IL
60585-1399
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-4169
  • Fax:
Mailing address:
  • Phone: 630-842-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: