Active NPI
Suvina Sallan
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1265946354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.019901
- Practice address
- 661 W Lake St Ste 2S
Chicago, IL 60661-1034 - Phone
- (270) 993-7171
- NPI assigned
- Nov 28, 2017
- Last updated
- May 18, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC200001472 | ||
| Clinical Social Worker | 1041C0700X | 149.019901 | IL | Primary |
Addresses
Primary practice location
661 W Lake St Ste 2S
Chicago, IL 60661-1034
Mailing address
661 W Lake St Ste 2S
Chicago, IL 60661-1034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 28, 2025 through Apr 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.019901 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684368000000",
"number": "1265946354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "661 W LAKE ST STE 2S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606611034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "661 W LAKE ST STE 2S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606611034",
"telephone_number": "270-993-7171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SALLAN",
"first_name": "SUVINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-28",
"last_updated": "2023-05-18",
"certification_date": "2023-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "LC200001472",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.019901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.