Active NPI
Kenneth Scott Martin, CADC
- Addiction (Substance Use Disorder) Counselor
- Rockford, IL
National Provider Identifier
1255438362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 13193
- Practice address
- 4940 E State St
Rockford, IL 61108-2270 - Phone
- (815) 227-0081
- Fax
- (815) 387-5316
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 13193 | IL | Primary |
Addresses
Primary practice location
4940 E State St
Rockford, IL 61108-2270
Mailing address
4940 E State St
Rockford, IL 61108-2270
Phone (815) 227-0081
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 |
|---|---|---|---|
| 13193 | IL | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255438362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4940 E STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082270",
"telephone_number": "815-227-0081",
"fax_number": "815-387-5316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4940 E STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082270",
"telephone_number": "815-227-0081",
"fax_number": "815-387-5316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KENNETH",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "13193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.