Individual provider Active NPI

Amber Nicole Shrum, LSW, CADC

  • Social Worker
  • Fox Lake, IL
National Provider Identifier
1013720382
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
150.114576 Issued in IL
Practice address
34 W Grand Ave Unit 101
Fox Lake, IL 60020-1224
Phone
(847) 322-2975
NPI assigned
Jan 29, 2025
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 39105 IL
Social Worker 104100000X 150.114576 IL Primary

Addresses

Primary practice location

34 W Grand Ave Unit 101
Fox Lake, IL 60020-1224

Mailing address

5807 Bunny Ave
McHenry, IL 60051-6268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250424003699 IL Practitioner - Clinical Social Worker 6103342878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Bailey Behavioral Health LLCGroup PAC ID 0547681058, 4 clinicians

Practice addresses (Care Compare)

34 W Grand Ave
Suite 101
Fox Lake, IL 60020-1224
Phone (847) 322-3975

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39105ILMDAddiction (Substance Use Disorder) Counselor
150.114576ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bailey Behavioral Health, PLLC CurrentSince Feb 1, 2025 Accepting new patients
Sheffer Psychological Services, PLLC CurrentSince Feb 1, 2025 Accepting new patients

Locations

34 W Grand Ave
Ste 101
Fox Lake, IL 60020
Phone (847) 322-3975

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1013720382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5807 BUNNY AVE",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600516268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 W GRAND AVE UNIT 101",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201224",
            "telephone_number": "847-322-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHRUM",
        "first_name": "AMBER",
        "middle_name": "NICOLE",
        "credential": "LSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "39105",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.114576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fox Lake, IL

Sources for this page

Verify at the official NPI Registry.