Individual provider Active NPI

Christina M Siemsen, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1184283020
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.021268 Issued in IL
Practice address
5610 W Bloomingdale Ave Ste 16
Chicago, IL 60639-4113
Phone
(872) 212-4143
NPI assigned
Jun 12, 2019
Last updated
Jan 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.021268 IL Primary

Addresses

Primary practice location

5610 W Bloomingdale Ave Ste 16
Chicago, IL 60639-4113

Mailing address

5610 W Bloomingdale Ave Ste 16
Chicago, IL 60639-4113
Phone (872) 212-4143

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.021268ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1184283020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5610 W BLOOMINGDALE AVE STE 16",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394113",
            "telephone_number": "872-212-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5610 W BLOOMINGDALE AVE STE 16",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394113",
            "telephone_number": "872-212-4143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEMSEN",
        "first_name": "CHRISTINA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2024-01-16",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.