Individual provider Active NPI

Ann Kawalski, LCSW

  • Clinical Social Worker
  • Park Ridge, IL
National Provider Identifier
1205295946
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.011207 Issued in IL
Practice address
1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1356
Phone
(773) 398-7464
NPI assigned
Feb 22, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 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 149.011207 IL Primary

Addresses

Primary practice location

1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1356

Mailing address

1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1356
Phone (773) 398-7464

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
I20160801000562 IL Practitioner - Clinical Social Worker 1951694769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Loyola University of Chicago, Stritch School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Juniper Center PCGroup PAC ID 1557557725, 26 clinicians

Practice addresses (Care Compare)

1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1471
Phone (847) 778-4533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.011207ILMDClinical Social Worker

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.

NPI Registry JSON

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1205295946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DR",
            "address_2": "SUITE 320",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681356",
            "telephone_number": "773-398-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DR",
            "address_2": "SUITE 320",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681356",
            "telephone_number": "773-398-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWALSKI",
        "first_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-22",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.011207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.