NPIMap

Organization Active NPI

Illinois Valley Counseling Services

  • Clinical Social Worker
  • Ottawa, IL
National Provider Identifier
1134568249
Registry record updated Jun 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149013269 Issued in IL
Legal business name
ILLINOIS VALLEY COUNSELING SERVICES
Practice address
807 Lasalle St
Ottawa, IL 61350-9144
Phone
(815) 993-1614
NPI assigned
Jun 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2013

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

Authorized official

Name
Mr. Shawn W Slagle, LCSWNPI 1043463268
Title
Owner
Phone
(815) 993-1614

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 149013269 IL Primary

Addresses

Primary practice location

807 Lasalle St
Ottawa, IL 61350-9144

Mailing address

1220 Tower Dr
Ottawa, IL 61350-9144
Phone (815) 993-1614

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131224000001 IL Part B Supplier - Clinic/Group Practice 0244467066 Receives reassigned benefits from 11 practitioners
Practice locations: Mendota, IL; Ottawa, IL

National Provider Directory

National Provider Directory

Locations

901 Main St
Ste A
Mendota, IL 61342
Phone (815) 538-7300

1802 N Division St
Ste 403
Morris, IL 60450
Phone (815) 993-1614

747 E Etna Rd
Ste B
Ottawa, IL 61350

747 E Etna Rd
#B
Ottawa, IL 61350
Phone (815) 993-1614

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1134568249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 TOWER DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613509144",
            "telephone_number": "815-993-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 LASALLE ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613509144",
            "telephone_number": "815-993-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VALLEY COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "SLAGLE",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-993-1614",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.