Active NPI
Jennifer Butz
- Clinical Social Worker
- Crystal Lake, IL
National Provider Identifier
1366951311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.019388
- Practice address
- 1095 Pingree Rd Ste 202
Crystal Lake, IL 60014-1727 - Phone
- (224) 456-9356
- NPI assigned
- Sep 21, 2017
- Last updated
- Mar 13, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.019388 | IL | Primary |
Addresses
Primary practice location
1095 Pingree Rd Ste 202
Crystal Lake, IL 60014-1727
Mailing address
6N002 E Ridgewood Dr
Saint Charles, IL 60175-6273
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.019388 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeview Counseling Services | Multi-Specialty | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lakeview Counseling & Consulting
- Mental Health Counselor
- Crystal Lake, IL
- NPI 1265951883
Multi-Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1366951311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6N002 E RIDGEWOOD DR",
"city": "SAINT CHARLES",
"state": "IL",
"postal_code": "601756273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1095 PINGREE RD STE 202",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600141727",
"telephone_number": "224-456-9356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTZ",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-21",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.019388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.