Active NPI
M Colleen King, LCSW CADC
- Clinical Social Worker
- Wheaton, IL
National Provider Identifier
1093063018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.014503
- Practice address
- 1761 S Naperville Rd Ste 200
Wheaton, IL 60189-5846 - Phone
- (630) 260-0606
- Fax
- (630) 260-1049
- NPI assigned
- Aug 23, 2012
- Sex
- Female
- Sole proprietor
- No
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 | 149.014503 | IL | Primary |
Addresses
Primary practice location
1761 S Naperville Rd Ste 200
Wheaton, IL 60189-5846
Mailing address
1761 S Naperville Rd Ste 200
Wheaton, IL 60189-5846
Phone (630) 260-0606
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 |
|---|---|---|---|
| 149.014503 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Clinical Services PC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345680000000",
"number": "1093063018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1761 S NAPERVILLE RD STE 200",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895846",
"telephone_number": "630-260-0606",
"fax_number": "630-260-1049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1761 S NAPERVILLE RD STE 200",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895846",
"telephone_number": "630-260-0606",
"fax_number": "630-260-1049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "M",
"middle_name": "COLLEEN",
"credential": "LCSW CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-23",
"last_updated": "2012-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.014503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.