Provider Demographics
NPI:1588142012
Name:STRYKER, KELLIE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:STRYKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8404
Mailing Address - Country:US
Mailing Address - Phone:779-800-5859
Mailing Address - Fax:
Practice Address - Street 1:85 N WILLIAMS ST STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4476
Practice Address - Country:US
Practice Address - Phone:779-800-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2023-02-08
Deactivation Date:2018-08-06
Deactivation Code:
Reactivation Date:2018-12-07
Provider Licenses
StateLicense IDTaxonomies
IL1490191671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical