Active NPI
Keith Bullock, LCSW, CADC
- Clinical Social Worker
- Oak Park, IL
National Provider Identifier
1083569354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149014572
- Practice address
- 607 Gunderson Ave
Oak Park, IL 60304-1421 - Phone
- (708) 445-8194
- NPI assigned
- Mar 3, 2026
- Sex
- Male
- 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 | 149014572 | IL | Primary |
Addresses
Primary practice location
607 Gunderson Ave
Oak Park, IL 60304-1421
Mailing address
607 Gunderson Ave
Oak Park, IL 60304-1421
Phone (708) 445-8194
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 |
|---|---|---|---|
| 149014572 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772496000000",
"number": "1083569354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 GUNDERSON AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041421",
"telephone_number": "708-445-8194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 GUNDERSON AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041421",
"telephone_number": "708-445-8194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "KEITH",
"name_prefix": "Mr.",
"credential": "LCSW, CADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-03",
"last_updated": "2026-03-03",
"certification_date": "2026-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149014572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.