Individual provider Active NPI

Jill Sanderson-Davis, LCSW

  • Clinical Social Worker
  • Glenview, IL
National Provider Identifier
1063664787
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.001197 Issued in IL
Practice address
2314 Swainwood Dr
Glenview, IL 60025-2742
Phone
(847) 999-3893
NPI assigned
Oct 13, 2008
Last updated
Jan 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.001197 IL Primary

Addresses

Primary practice location

2314 Swainwood Dr
Glenview, IL 60025-2742

Mailing address

2314 Swainwood Dr
Glenview, IL 60025-2742
Phone (847) 997-5664

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
I20091013000686 IL Practitioner - Clinical Social Worker 5193861607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Parkside Psychological Services, LLCGroup PAC ID 7416358155, 4 clinicians

Practice addresses (Care Compare)

840 S Waukegan Rd
Suite 203
Lake Forest, IL 60045-2619
Phone (847) 420-5088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.001197ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Parkside Psychological Services, LLC CurrentSince Nov 4, 2024 Accepting new patients
Monarch Counseling Associates PLLC Clinical CurrentSince Nov 1, 2024 Accepting new patients

Locations

840 S Waukegan Rd
Ste 203
Lake Forest, IL 60045
Phone (847) 420-5088

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": "1223856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1063664787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 SWAINWOOD DR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600252742",
            "telephone_number": "847-997-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 SWAINWOOD DR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600252742",
            "telephone_number": "847-999-3893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON-DAVIS",
        "first_name": "JILL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-13",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.001197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.