Rose Marie Wyatt, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149000239 Issued in IL

Practice address

5201 S Cornell Ave Apt 8C
Chicago, IL 60615-4202

Phone

(773) 852-7420

NPI assigned

Mar 19, 2012

Last updated

Mar 19, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Rose Marie Kenner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1255606695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 S CORNELL AVE APT 8C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154202",
            "telephone_number": "773-852-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 S CORNELL AVE APT 8C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154202",
            "telephone_number": "773-852-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "ROSE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149000239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSE",
            "last_name": "KENNER",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Helen Wyatt
• James Kelley Wyatt, PH.D.
• Joel Daniel Wyatt, MS
• Laura Wyatt
• Matthew Monroe Wyatt, M.D.
• Hannah Wychocki, PA-C
• Suzanne Wychocki, LCSW
• Mairghread R Wycklendt, RD, LDN
• Kelly Wyckoff, MS, RD, LDN, CNSD
• Sarah L Wyckoff

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.