Jodie Kennedy, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.014109 Issued in IL

Practice address

3412 S Illinois Ave
Carbondale, IL 62903-8362

Phone

(618) 327-1304

Fax

(618) 457-8844

NPI assigned

Apr 20, 2010

Sex

Female

Sole proprietor

Yes

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

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Shawler Psychology, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Carbondale, IL
  • NPI 1710648605
  NPD
• Naeem a Qureshi PC

  • Psychiatry Physician
  • Marion, IL
  • NPI 1467492298
  NPD (past)
• Nicole Douglas Psychology and Wellness, PLLC

  • Clinical Psychologist
  • Carbondale, IL
  • NPI 1245181379
  NPD (past)

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1083930705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 S ILLINOIS AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629038362",
            "telephone_number": "618-327-1304",
            "fax_number": "618-457-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 S ILLINOIS AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629038362",
            "telephone_number": "618-327-1304",
            "fax_number": "618-457-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JODIE",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.014109",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "149-014109",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Kristen Adele Keller
• Jessica C Kelley, DPT
• Jeffrey Saunders Kellogg, PSY.D
• Dina Kelly
• Constance Susan Kemp, M.D.
• Gardner Thomas Kenny, M.D.
• Christopher Ryan Kent
• Teresa Ann Kent, LCSW, ACSW
• Emily Elise Kermicle, PA-C
• Sarah Kertz, PH.D.

• Clinical Social Worker in Carbondale, IL
• Providers in Carbondale, 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 Nov 15, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.