Provider Demographics
NPI:1588979785
Name:KROLAK, KAREN A (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:KROLAK
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 1:1802 DIVISION ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-941-3882
Mailing Address - Fax:815-941-3884
Practice Address - Street 1:112 W CENTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3557
Practice Address - Country:US
Practice Address - Phone:815-433-5101
Practice Address - Fax:815-433-5102
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490112531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical