Kelly Anne Long

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149027456 Issued in IL

Practice address

108 W Market St
Bloomington, IL 61701-3918

Phone

(309) 827-5351

Fax

(309) 829-6808

NPI assigned

Sep 2, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thriveworks Clinical - IllinoisGroup PAC ID 6800263823, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thriveworks Clinical - Illinois

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1164190633

  IL

  Medicare reassignment Care Compare group NPD
• Allone Health Well LLC

  • Mental Health Counselor
  • Wilkes Barre, PA
  • NPI 1659268043
  NPD

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1154423937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 CHIPPEWA ST",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615758",
            "telephone_number": "309-530-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W MARKET ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013918",
            "telephone_number": "309-827-5351",
            "fax_number": "309-829-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149027456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis L Lockhart, M.D.
• Melissa Jomarie Lockwood, D.P.M.
• Paula D. Lodge
• Jeffrey M. Loeb, M.S.W., L.C.S.W.
• Amy Long, MS, LSW
• Grace Elizabeth Longstreth
• Marvin Loos, CRNA
• Craig Walter Lopatka, DDS, MD
• Diana Lopez
• Lorio Counseling Services LLC

• All providers in Bloomington, IL
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.