Active NPI
Kalyn Zeller, LCSW
- Social Worker
- Mount Vernon, IL
National Provider Identifier
1386022937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 2011028236
- Practice address
- 2020 Broadway St
Suite C
Mount Vernon, IL 62864-2973 - Phone
- (314) 627-0313
- NPI assigned
- May 15, 2015
- Reactivated
- May 3, 2024
- Last updated
- May 3, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 2011028236 | MO | Primary |
Addresses
Primary practice location
2020 Broadway St
Suite C
Mount Vernon, IL 62864-2973
Mailing address
2020 Broadway St # C
Mount Vernon, IL 62864-2973
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2011028236 | MO | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714694400000",
"number": "1386022937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 BROADWAY ST # C",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628642973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 BROADWAY ST",
"address_2": "SUITE C",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628642973",
"telephone_number": "314-627-0313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZELLER",
"first_name": "KALYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-15",
"last_updated": "2024-05-03",
"certification_date": "2021-02-22",
"deactivation_date": "2021-02-22",
"reactivation_date": "2024-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MO",
"license": "2011028236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.