Audrey R. Davis, ED.D., MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.019648 Issued in IL

Practice address

494 W Boughton Rd Ste 4B
Bolingbrook, IL 60440-1881

Phone

(630) 863-0408

Fax

(815) 714-6220

NPI assigned

Nov 8, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Hope Behavior Practice

  • Clinical Social Worker
  • Joliet, IL
  • NPI 1033626932
  NPD Authorized official

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644019200000",
    "number": "1255844692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 BROOKWOOD LN E",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604405517",
            "telephone_number": "630-863-0408",
            "fax_number": "815-714-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 W BOUGHTON RD STE 4B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401881",
            "telephone_number": "630-863-0408",
            "fax_number": "815-714-6220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "AUDREY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "ED.D., MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2022-02-05",
        "certification_date": "2022-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dark Star Transit Inc.
• Datta Sambare M D S C
• Ramadevi Davarapalli, MD
• Katrina Morta David, OTRL
• Sarah Rebecca Davies, MS, ATC/L
• Katie Davis
• Susan M Davis, ND, FNP-BC
• Victoria E Davis, DC
• Nicole Day
• Kristen Deangelis, MHS, CCC-SLP/L

• Clinical Social Worker in Bolingbrook, IL
• Providers in Bolingbrook, 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 Feb 5, 2022; 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.