Individual
MS. ANN K O'KLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4455 E 56TH ST, DAVENPORT, IA 52807-2995
(563) 355-2577
(563) 355-4015
Mailing address
4455 E 56TH ST, DAVENPORT, IA 52807-2995
(563) 355-2577
(563) 355-4015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149002121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0581744
—
IL
01
—
149002121
BLUE CROSS ILLINOIS NUMBE
IL
01
—
99089
BLUE CROSS IOWA NUMBER
IL
01
—
IL01E1
JOHN DEERE PROVIDER NUMBE
IL
Enumeration date
08/26/2005
Last updated
08/12/2022
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