William Kelvyn Smith, ED.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149009435 Issued in IL

Practice address

605 Piccadilly LN
Bolingbrook, IL 60440-1021

Phone

(630) 673-2040

NPI assigned

Jun 28, 2023

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1164109591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 PICCADILLY LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401021",
            "telephone_number": "630-673-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 PICCADILLY LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401021",
            "telephone_number": "630-673-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WILLIAM",
        "middle_name": "KELVYN",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149009435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lateena Smith, EDS
• Latrina Smith, LCSW
• Sarah Catherine Smith, M.P.T.
• Tara Smith, LCSW
• Tara E Smith, PT
• Gina Marie Smoger, RDH
• Sneha Naik DDS PLLC
• Bao Ling Pauline Soh
• Rajwant Kaur Sohal
• Stephanie L Sojka, MPH, CHES, WHE

• Clinical Social Worker in Bolingbrook, IL
• Providers in Bolingbrook, 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 Jun 28, 2023; 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.