Kathleen Diane Ely, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.012496 Issued in IL

Practice address

172 Brookhaven Court
Sugar Grove, IL 60554

Phone

(630) 466-0019

Fax

(630) 809-5062

NPI assigned

Jul 6, 2009

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253664000000",
    "number": "1104055714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 BROOKHAVEN COURT",
            "city": "SUGAR GROVE",
            "state": "IL",
            "postal_code": "60554",
            "telephone_number": "630-466-0019",
            "fax_number": "630-809-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 BROOKHAVEN COURT",
            "city": "SUGAR GROVE",
            "state": "IL",
            "postal_code": "60554",
            "telephone_number": "630-466-0019",
            "fax_number": "630-809-5062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELY",
        "first_name": "KATHLEEN",
        "middle_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-06",
        "last_updated": "2009-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149012496",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.012496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Dougherty, CRNP
• Dr. Satyen Patel LTD
• Candice Grace Dubeau
• Mary E Eberhardt
• Elgersma Counseling Services PLLC
• Iris Miriam Espinoza
• Justine Rundina Everhart, PTA
• Donald J Fee, D.D.S.
• Emily Forbes
• Andrea Joan Frale-Klouda, RD MPH CCN LDN

• Clinical Social Worker in Sugar Grove, IL
• Providers in Sugar Grove, 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 Sep 23, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.