MEDICARE: OPTIMAL CHANGE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578134268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL CHANGE, PLLC

Provider Business Mailing Address
First Line	:	3800 E LAKE CTR STE 100C
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-5839
Country	:	US
Telephone Number	:	217-740-2719
Fax Number	:	877-860-2719

Provider Business Practice Location Address
First Line	:	3800 E LAKE CTR STE 100C
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-5839
Country	:	US
Telephone Number	:	217-740-2719
Fax Number	:	877-860-2719

Authorized Official
Title or Position	:	BEHAVIORAL HEALTH THERAPIST
Name	:	KETTISHA HODGES
Credential	:	LCSW
Telephone Number	:	573-406-2473

Provider Enumeration Date	:	07/05/2021
Last Update Date	:	04/06/2026

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Directions to “OPTIMAL CHANGE, PLLC ” Practice Location

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