Mari Evonne Kong, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.005213 Issued in IL

Practice address

5301 E State St Ste 101
Rockford, IL 61108-2388

Phone

(815) 397-8500

Fax

(815) 397-8588

NPI assigned

Dec 14, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mari Evonne Kong Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Back in Action Holistic Health Center

  • Chiropractor
  • Rockford, IL
  • NPI 1063554343
  NPD (past)
• Northern Illinois Medical Group S. C.

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1861670101
  NPD (past)

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

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1093044455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 E STATE ST STE 101",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082388",
            "telephone_number": "815-397-8500",
            "fax_number": "815-397-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E STATE ST STE 101",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082388",
            "telephone_number": "815-397-8500",
            "fax_number": "815-397-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "MARI",
        "middle_name": "EVONNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-14",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.005213",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1605-123",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "612-124",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARI",
            "last_name": "KONG",
            "middle_name": "EVONNE",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ryan Kohl, OTR/L
• Sarah Kohl, LCSW
• Dean J. Kokinias, D.D.S.
• Kelly Nicole Kolodzik
• Andrew Kong, DC
• Karin Koonmen, CCC-SLP-L
• William Alan Kopke, MED, OTR/L, CLT
• Kenneth J Korcek, M.D.
• Susan A Korf, N.P.
• Timothy N. Koritz, MD

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 Dec 14, 2009; 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.