Individual provider Active NPI

Shannon Dudzienski, LCSW

  • Clinical Social Worker
  • Wheaton, IL
National Provider Identifier
1164162921
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149029653 Issued in IL
Practice address
2S344 Seneca Dr
Wheaton, IL 60189-5965
Phone
(630) 800-5650
NPI assigned
Mar 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 150105087 IL
Clinical Social Worker 1041C0700X 149029653 IL Primary
Social Worker 104100000X
Social Worker 104100000X 150105087 IL

Addresses

Primary practice location

2S344 Seneca Dr
Wheaton, IL 60189-5965

Mailing address

55 E Loop Rd Ste 301
Wheaton, IL 60189-1938

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251112002450 IL Practitioner - Clinical Social Worker 2062903545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

55 E Loop Rd
Wheaton, IL 60189-1938
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150105087ILMDCounselor
149029653ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Clinical CurrentSince Sep 4, 2025 Accepting new patients
Psychology Specialists LTD Counselor Past Accepting new patients

Locations

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

55 E Loop Rd
Ste 301
Wheaton, IL 60189
Phone (630) 690-7300

55 E Loop Rd
Wheaton, IL 60189
Phone (630) 653-8899

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1164162921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E LOOP RD STE 301",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601891938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2S344 SENECA DR",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895965",
            "telephone_number": "630-800-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDZIENSKI",
        "first_name": "SHANNON",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-30",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "150105087",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149029653",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150105087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.