Chanel Kolthoff, LICSW, LCSW
Individual provider Active NPI Clinical Social Worker · Savoy, IL
NPI 1508425547 · NPPES record last updated Dec 31, 2024
Key facts
- NPI
- 1508425547
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 61169653 (WA)
- Practice address
- 1008 Declaration Dr
Savoy, IL 61874-7104 - Phone
- (580) 695-0526
- NPI assigned
- Jun 12, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149027046 | IL | MD | Clinical Social Worker |
| 114763 | TX | MD | Clinical Social Worker |
| 0904014795 | VA | MD | Clinical Social Worker |
| 61169653 | WA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Digestive Health & Nutrition, PLLC | Current |
Accepting new patients |
Locations
900 Rand Rd
Ste 120
Des Plaines, IL 60016
Phone (312) 623-8993
950 N York Rd
Ste 101
Hinsdale, IL 60521
Phone (312) 767-3244
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149027046 | IL | |
| Clinical Social Worker | 1041C0700X | 0904014795 | VA | |
| Clinical Social Worker | 1041C0700X | 114763 | TX | |
| Clinical Social Worker | 1041C0700X | 61169653 | WA | Yes |
Addresses
Primary practice location
1008 Declaration Dr
Savoy, IL 61874-7104
Mailing address
1008 Declaration Dr
Savoy, IL 61874-7104
Other providers in Savoy, IL
- Katie Martin Therapy, LLC
- Kari Jo Keller
- Kyung Sook Kim
- Marilyn L Kohl
- Kimberly Ann Kolarik
- Jacqueline Kronlund
- Shu Hau Lam
- Dana Louise Lamkin
- Launchpoint Therapy
- Logan Lauritzen
All providers in Savoy, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.