Individual provider Active NPI

Jody Marie Kanikula, LCSW

  • Clinical Social Worker
  • Batavia, IL
National Provider Identifier
1396176988
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149015443 Issued in IL
Practice address
439 Elizabeth St
Batavia, IL 60510
Phone
(630) 482-9182
NPI assigned
Dec 6, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 149015443 IL Primary

Addresses

Primary practice location

439 Elizabeth St
Batavia, IL 60510

Mailing address

439 Elizabeth St
Batavia, IL 60510-2131
Phone (630) 482-9182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160226001748 IL Practitioner - Clinical Social Worker 3870898935 Practice locations: Batavia, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

439 Elizabeth St
Batavia, IL 60510-2131
Phone (630) 482-9182

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396176988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 ELIZABETH ST",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605102131",
            "telephone_number": "630-482-9182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 ELIZABETH ST",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "60510",
            "telephone_number": "630-482-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANIKULA",
        "first_name": "JODY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Batavia, IL

Sources for this page

Verify at the official NPI Registry.