Provider Demographics
NPI:1053183855
Name:COLBERT, JODI (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 JOSTES RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-8425
Mailing Address - Country:US
Mailing Address - Phone:217-801-1524
Mailing Address - Fax:
Practice Address - Street 1:542 JOSTES RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-8425
Practice Address - Country:US
Practice Address - Phone:217-801-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490213361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical