MEDICARE: KATIE KOLZOW LCSW

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	149.026943	IL

General Provider Information

NPI Number	:	1851776009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE KOLZOW LCSW

Provider Business Mailing Address
First Line	:	1449 N ARTESIAN AVE APT 1R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1707
Country	:	US
Telephone Number	:	630-217-7182
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4324
Country	:	US
Telephone Number	:	773-279-3736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	04/02/2024

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