Candice Jane Child-Illum, CSW, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11187387-3502 Issued in UT

Practice address

3149 N Highway 89 Ste 200
Pleasant View, UT 84404-1202

Phone

(801) 782-6600

NPI assigned

Jul 8, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

• Mountain View Counseling of North Ogden

  • Mental Health Counselor
  • Ogden, UT
  • NPI 1457068512

  UT

  Medicare reassignment NPD Authorized official
• Milestone Counseling Services

  • Community/Behavioral Health Agency
  • Pleasant View, UT
  • NPI 1588850846
  NPD (past)

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1023670262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3149 N HIGHWAY 89 STE 200",
            "city": "PLEASANT VIEW",
            "state": "UT",
            "postal_code": "844041202",
            "telephone_number": "801-782-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3149 N HIGHWAY 89 STE 200",
            "city": "PLEASANT VIEW",
            "state": "UT",
            "postal_code": "844041202",
            "telephone_number": "801-782-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILD-ILLUM",
        "first_name": "CANDICE",
        "middle_name": "JANE",
        "credential": "CSW, MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "11187387-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hilary Black, LCSW
• Bridger G Butters, PA-C
• Brian K Campbell, LMFT
• Capitol Dental Inc.
• Chad T Eardley DMD PLLC
• Choice Counseling & Consulting
• Choice Supported Employment Services Inc
• Jordan Miles Christensen, DDS
• Travis Clyde Christensen, LPC
• Van G Christiansen, MD

• All providers in Pleasant View, UT
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.