Samantha Ann Kimble, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.024233 Issued in IL

Practice address

205 Bailey LN Ste 3W
Benton, IL 62812-1921

Phone

(618) 218-4544

NPI assigned

Jun 25, 2020

Last updated

Apr 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Southern Illinois Therapy Services, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Benton, IL
  • NPI 1891435657
  NPD Authorized official

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1083230098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE 3W",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-218-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE 3W",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-218-4544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 W Main St",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629591188",
            "country_code": "US",
            "telephone_number": "618-218-4544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "SAMANTHA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-25",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150104375",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathalynas Spine, Sport & Rehabilitation LLC
• Allyson Lynne Kathalynas, D. C.
• Ryan Kathalynas, DC
• Ashley S Kaytor-McCoy, MD
• Saeed Ahmad Khan, MD
• Kimmel-Chaplain Pharmacy LTD (Kimmel-Chaplain Pharmacy)
• Kayla Lorraine Kimmel, FNP
• Jenna Kirkpatrick, PHARMD
• Logan Edward Kirkpatrick, RN
• Luke William Koehn, D.C.

• Clinical Social Worker in Benton, IL
• Providers in Benton, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.