Active NPI
Nicole Waldecker, MSW, LSW
- Social Worker
- Joliet, IL
National Provider Identifier
1386393189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 106552
- Practice address
- 2301 Glenwood Ave
Joliet, IL 60435-5481 - Phone
- (815) 730-8221
- NPI assigned
- Mar 21, 2022
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 106552 | IL | Primary |
Addresses
Primary practice location
2301 Glenwood Ave
Joliet, IL 60435-5481
Mailing address
2301 Glenwood Ave
Joliet, IL 60435-5481
Phone (815) 730-8221
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 |
|---|---|---|---|
| 106552 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Services Inc. | 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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Joliet, IL
- NPI 1003085770
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648166400000",
"number": "1386393189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 GLENWOOD AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604355481",
"telephone_number": "815-730-8221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 GLENWOOD AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604355481",
"telephone_number": "815-730-8221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDECKER",
"first_name": "NICOLE",
"credential": "MSW, LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-21",
"last_updated": "2022-03-25",
"certification_date": "2022-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "106552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.