Individual provider Active NPI

Gina M Winiecki, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1306432117
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.019203 Issued in IL
Practice address
10801 S Western Ave Ste 2B
Chicago, IL 60643-3225
Phone
(773) 474-9840
NPI assigned
Dec 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.019203 IL Primary

Addresses

Primary practice location

10801 S Western Ave Ste 2B
Chicago, IL 60643-3225

Mailing address

4704 W 106TH PL
Oak Lawn, IL 60453-5225
Phone (312) 919-1646

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

LicenseStateTypeSpecialty
149.019203ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mirjam Quinn and Associates, LTD CurrentSince Oct 17, 2023 Accepting new patients

Locations

10801 S Western Ave
Ste 2B
Chicago, IL 60643
Phone (708) 499-3525

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1306432117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4704 W 106TH PL",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604535225",
            "telephone_number": "312-919-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 S WESTERN AVE STE 2B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606433225",
            "telephone_number": "773-474-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINIECKI",
        "first_name": "GINA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019203",
            "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 Dec 15, 2020; 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.