Active NPI
Gwendolyn Haywood, LCSW
- Clinical Social Worker
- Oak Park, IL
National Provider Identifier
1053447326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-012141
- Practice address
- 14 Lake St
Oak Park, IL 60302-2606 - Phone
- (708) 524-7684
- Fax
- (708) 383-9911
- NPI assigned
- Feb 23, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 149-012141 | IL | Primary |
Addresses
Primary practice location
14 Lake St
Oak Park, IL 60302-2606
Mailing address
14 Lake St
Oak Park, IL 60302-2606
Phone (708) 524-7684
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149-012141 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-012141 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577145600000",
"number": "1053447326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 LAKE ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022606",
"telephone_number": "708-524-7684",
"fax_number": "708-383-9911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 LAKE ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022606",
"telephone_number": "708-524-7684",
"fax_number": "708-383-9911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYWOOD",
"first_name": "GWENDOLYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2019-12-24",
"certification_date": "2019-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-012141",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "149-012141",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
- Jill Hawkes, APN
- Michael Zollie Hawkins, LCPC
- Jamie Lynn Hayden, L.C.S.W.
- Madison Julia Hayes
- Karla Renee Hayter, PHYSICAL THERAPIST
- Health Delivery Management L L C (Home Infusion Solutions)
- Health Delivery Management, LLC (Rush Medical Office Building Pharmacy)
- Health Delivery Management, LLC (Rush Medical Office Building Pharmacy)
- Health Delivery Management, LLC (Home Infusion Solutions)
- Health Engagement, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.