Active NPI
Kimberly A Boersma
- Social Worker
- Crystal Lake, IL
National Provider Identifier
1235389487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.011243
- Practice address
- 411 E Congress Pkwy
Suite B
Crystal Lake, IL 60014-6247 - Phone
- (815) 459-3810
- Fax
- (815) 356-3550
- NPI assigned
- Sep 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.011243 | IL | Primary |
Addresses
Primary practice location
411 E Congress Pkwy
Suite B
Crystal Lake, IL 60014-6247
Mailing address
411 E Congress Pkwy
Suite B
Crystal Lake, IL 60014-6247
Phone (815) 459-3810
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.011243 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milestones Therapy Center P.C. | Past | Accepting new patients |
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.
-
- Occupational Therapist
- Crystal Lake, IL
- NPI 1275792616
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222214400000",
"number": "1235389487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 E CONGRESS PKWY",
"address_2": "SUITE B",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600146247",
"telephone_number": "815-459-3810",
"fax_number": "815-356-3550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 E CONGRESS PKWY",
"address_2": "SUITE B",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600146247",
"telephone_number": "815-459-3810",
"fax_number": "815-356-3550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERSMA",
"first_name": "KIMBERLY",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-24",
"last_updated": "2008-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.011243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.