Provider Demographics
NPI:1821974015
Name:STOLTZ, CHARNE
Entity type:Individual
Prefix:
First Name:CHARNE
Middle Name:
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 W SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61607-9349
Mailing Address - Country:US
Mailing Address - Phone:309-857-3815
Mailing Address - Fax:
Practice Address - Street 1:5101 N EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4868
Practice Address - Country:US
Practice Address - Phone:309-408-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker