Katey Kollereb, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149017525 Issued in IL

Practice address

103 N 11TH Ave Ste 106
St Charles, IL 60174-2278

Phone

(630) 296-4169

NPI assigned

Oct 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 10, 2023 through Nov 10, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Obsidian Behavioral Health PLLC

  • Clinical Social Worker
  • Saint Charles, IL
  • NPI 1841873577
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1558024125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12934 SUMMER HOUSE DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605851399",
            "telephone_number": "630-842-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N 11TH AVE STE 106",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742278",
            "telephone_number": "630-296-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLEREB",
        "first_name": "KATEY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Koenen
• Erin Koenig, MPT
• Karolyn Koenig, MPT
• Gary Marshall Kohn, MD
• Martin L Kolinski, DDS
• Alexandra Komar
• Jill M Kombrink
• Joanna Edyta Konopka
• Victoria Katherine Korpitz
• Bethany M Kosek

• Clinical Social Worker in St Charles, IL
• Providers in St Charles, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.