Active NPI
Katie Cockrell, LCSW
- Clinical Social Worker
- Wheaton, IL
National Provider Identifier
1124416854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.016479
- Practice address
- 2100 Manchester Rd Ste 1510
Wheaton, IL 60187-4561 - Phone
- (630) 653-1717
- Fax
- (630) 653-7926
- NPI assigned
- Jan 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | 149.016479 | IL | Primary |
Addresses
Primary practice location
2100 Manchester Rd Ste 1510
Wheaton, IL 60187-4561
Mailing address
2100 Manchester Rd Ste 1510
Wheaton, IL 60187-4561
Phone (630) 653-1717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 6, 2022 through Dec 6, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.016479 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420416000000",
"number": "1124416854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 MANCHESTER RD STE 1510",
"city": "WHEATON",
"state": "IL",
"postal_code": "601874561",
"telephone_number": "630-653-1717",
"fax_number": "630-653-7926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 MANCHESTER RD STE 1510",
"city": "WHEATON",
"state": "IL",
"postal_code": "601874561",
"telephone_number": "630-653-1717",
"fax_number": "630-653-7926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COCKRELL",
"first_name": "KATIE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-05",
"last_updated": "2015-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.016479",
"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 Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.