Shelly L Patchett, LCSW
Individual provider Active NPI Clinical Social Worker · Rockton, IL
NPI 1215070487 · NPPES record last updated Jul 8, 2013
Key facts
- NPI
- 1215070487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.009828 (IL)
- Practice address
- 1107 N Blackhawk Blvd
Suite 8
Rockton, IL 61072-1500 - Phone
- (815) 494-9115
- Fax
- (815) 926-5301
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1047 Cannell CT
Rockton, IL 61072-1596
Phone (815) 494-9115
222 W Main St
Rockton, IL 61072-2419
Phone (815) 494-9115
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140527001480 | IL | Practitioner - Clinical Social Worker | 3577786243 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.009828 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stateline Counseling Services LLC | Clinical | Current |
Accepting new patients |
Locations
1107 N Blackhawk Blvd
Ste 8
Rockton, IL 61072
Phone (815) 494-9115
222 W Main St
Rockton, IL 61072
Phone (815) 494-9115
1047 Cannell Ct
Rockton, IL 61072
Phone (815) 703-0934
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.009828 | IL | Yes |
Addresses
Primary practice location
1107 N Blackhawk Blvd
Suite 8
Rockton, IL 61072-1500
Mailing address
1107 N Blackhawk Blvd
Suite 8
Rockton, IL 61072-1500
Phone (815) 494-9115
Other providers in Rockton, IL
- Vasil Nika
- Kenneth O'Brien
- Orthomidwest, PLLC
- Theresa Ann Oster
- Erin Lynn Parker
- Mark Peters
- Hannah Proctor
- Rhonda Christel Raedeke
- Keegan Thomas Ray
- Kathleen Reese
All providers in Rockton, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.