Active NPI
Kathleen Susan Dombeck, LCSW
- Clinical Social Worker
- Machesney Park, IL
National Provider Identifier
1043561772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.014659
- Practice address
- 7247 Chandan Blvd
Machesney Park, IL 61115-7660 - Phone
- (630) 981-4330
- NPI assigned
- Sep 20, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.014659 | IL | Primary |
Addresses
Primary practice location
7247 Chandan Blvd
Machesney Park, IL 61115-7660
Mailing address
7247 Chandan Blvd
Machesney Park, IL 61115-7660
Phone (630) 981-4330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.014659 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348099200000",
"number": "1043561772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7247 CHANDAN BLVD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611157660",
"telephone_number": "630-981-4330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7247 CHANDAN BLVD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611157660",
"telephone_number": "630-981-4330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMBECK",
"first_name": "KATHLEEN",
"middle_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-20",
"last_updated": "2012-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.014659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machesney Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.