Provider Demographics
NPI:1144821299
Name:FARLOW, KELLI (LCSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:FARLOW
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:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-0345
Mailing Address - Country:US
Mailing Address - Phone:312-888-2986
Mailing Address - Fax:863-268-5111
Practice Address - Street 1:213 N MORGAN ST UNIT 1D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1721
Practice Address - Country:US
Practice Address - Phone:312-888-2986
Practice Address - Fax:863-268-5111
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490226501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149022650OtherLCSW