Kimberly Michelle Henderson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.030687 Issued in IL

Practice address

6392 Linden Rd
Rockford, IL 61109-2816

Phone

(779) 368-0060

NPI assigned

Jun 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Michelle Lewis Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optum Behavioral Care Therapy Services of Illinois PC

  dba KP Counseling of Illinois

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1235949553
  NPD
• Optum Behavioral Care Therapy Services of Illinois PC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1780579797
  NPD
• KP Counseling LTD

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1770630766
  NPD (past)

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767657600000",
    "number": "1255956942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.030687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "LEWIS",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joel B Hellman, M.D.
• William C. Hellyer Jr., MBA, OTR/L
• Helping Hands Independent Living LLC
• Alice N Hemenway, PHARMD
• Martrice Denise Henderson-Aldridge, LCSW
• Shannon Henderson
• Mariah Hendrickson, OTR/L
• Ashley Hendrix, LSW
• Thomas Joseph Henneberry IV
• Ania Katarzyna Henning, MD

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.