Michael Mudgett, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018688 Issued in IL

Practice address

5524 W Harrison St
Chicago, IL 60644-5032

Phone

(773) 854-5073

Fax

(773) 379-0971

NPI assigned

Jul 15, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1134536865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S CENTRAL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606445059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606445032",
            "telephone_number": "773-854-5073",
            "fax_number": "773-379-0971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDGETT",
        "first_name": "MICHAEL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-15",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "383274841",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sukhraj Mudahar, PHARM.D.
• Luke Anthony Mudd, PSYD
• Marta Karolina Mudd, MD, PHD
• Savannah Mudd, LPC
• Seth Paul Mudd, LCSW
• Kristi Lynn Mudie, NP
• Mudita Counseling and Counsulting LLC
• Jared Tyler Mudlong Delapaz, MD
• Robyn Mudro Flanders, N.P.
• Audrey J Mudroch, PHARM D

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Jan 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.