Active NPI
Katelyn Belle Van Vickle, LSW
- Social Worker
- Gibson City, IL
National Provider Identifier
1104582451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.105484
- Practice address
- 7 Doctors Park
Gibson City, IL 60936-2000 - Phone
- (217) 784-5500
- Fax
- (217) 784-4106
- NPI assigned
- Nov 11, 2021
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.105484 | IL | Primary |
Addresses
Primary practice location
7 Doctors Park
Gibson City, IL 60936-2000
Mailing address
7 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-5500
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 |
|---|---|---|---|
| 150.105484 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1104582451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 DOCTORS PARK",
"city": "GIBSON CITY",
"state": "IL",
"postal_code": "609362000",
"telephone_number": "217-784-5500",
"fax_number": "217-784-4106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 DOCTORS PARK",
"city": "GIBSON CITY",
"state": "IL",
"postal_code": "609362000",
"telephone_number": "217-784-5500",
"fax_number": "217-784-4106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN VICKLE",
"first_name": "KATELYN",
"middle_name": "BELLE",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-11",
"last_updated": "2021-11-11",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.105484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gibson City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.