Active NPI
Jennifer Lauren Larsen, LCSW
- Social Worker
- Dekalb, IL
National Provider Identifier
1396394649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 12 Health Services Dr
Dekalb, IL 60115-9637 - Phone
- (815) 756-4875
- NPI assigned
- Sep 10, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.022626 | IL | |
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
12 Health Services Dr
Dekalb, IL 60115-9637
Mailing address
PO Box 1109
Dekalb, IL 60115-7109
Phone (815) 756-4875
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 474579189001 | Medicaid | IL |
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 |
|---|---|---|---|
| 149.022626 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602547200000",
"number": "1396394649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1109",
"city": "DEKALB",
"state": "IL",
"postal_code": "601157109",
"telephone_number": "815-756-4875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 HEALTH SERVICES DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159637",
"telephone_number": "815-756-4875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JENNIFER",
"middle_name": "LAUREN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-10",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.022626",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "474579189001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.