Active NPI
Jeffrey Gerard Larson
- Clinical Social Worker
- Saint Charles, IL
National Provider Identifier
1154657245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149012296
- Practice address
- 451 Dunham Rd
Suite 400
Saint Charles, IL 60174-1431 - Phone
- (630) 444-1801
- Fax
- (630) 444-0494
- NPI assigned
- Oct 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 | 149012296 | IL | Primary |
Addresses
Primary practice location
451 Dunham Rd
Suite 400
Saint Charles, IL 60174-1431
Mailing address
451 Dunham Rd
Suite 400
Saint Charles, IL 60174-1431
Phone (630) 444-1801
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235255993 | Other | IL | NPI |
| 149012296 | Other | IL | IL CLINICAL SOCIAL WORKER LICENSE |
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 |
|---|---|---|---|
| 149012296 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dunham Counseling Center, LTD. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- St Charles, IL
- NPI 1235255993
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256256000000",
"number": "1154657245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 DUNHAM RD",
"address_2": "SUITE 400",
"city": "SAINT CHARLES",
"state": "IL",
"postal_code": "601741431",
"telephone_number": "630-444-1801",
"fax_number": "630-444-0494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 DUNHAM RD",
"address_2": "SUITE 400",
"city": "SAINT CHARLES",
"state": "IL",
"postal_code": "601741431",
"telephone_number": "630-444-1801",
"fax_number": "630-444-0494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JEFFREY",
"middle_name": "GERARD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-23",
"last_updated": "2009-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149012296",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1235255993",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL CLINICAL SOCIAL WORKER LICENSE",
"identifier": "149012296",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.