Active NPI
Kristin Beckstrom Radcliffe, MSW, LCSW
- Clinical Social Worker
- O Fallon, IL
National Provider Identifier
1134497712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149014068
- Practice address
- 8 Eagle Ctr
Suite 4
O Fallon, IL 62269-1947 - Phone
- (618) 616-1235
- NPI assigned
- Dec 9, 2011
- 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 | 149014068 | IL | Primary |
Addresses
Primary practice location
8 Eagle Ctr
Suite 4
O Fallon, IL 62269-1947
Mailing address
8 Eagle Ctr
Suite 4
O Fallon, IL 62269-1947
Phone (618) 616-1235
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 |
|---|---|---|---|
| 149014068 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323388800000",
"number": "1134497712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 EAGLE CTR",
"address_2": "SUITE 4",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691947",
"telephone_number": "618-616-1235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 EAGLE CTR",
"address_2": "SUITE 4",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691947",
"telephone_number": "618-616-1235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADCLIFFE",
"first_name": "KRISTIN",
"middle_name": "BECKSTROM",
"credential": "MSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-09",
"last_updated": "2011-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149014068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.