Kassandra Jediola, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.017240 Issued in IL

Practice address

631 S 1St St
Dekalb, IL 60115-4117

Phone

(815) 756-8501

Fax

(815) 756-2944

NPI assigned

Feb 27, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Social Worker

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dekalb Behavioral Health Foundation, Inc.Group PAC ID 9436451655, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dekalb Behavioral Health Foundation, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dekalb, IL
  • NPI 1255703450
  Medicare reassignment Care Compare group NPD
• Dekalb Behavioral Health Foundation, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Sandwich, IL
  • NPI 1487015194
  NPD

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1427322130",
    "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": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "815-756-8501",
            "fax_number": "815-756-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDIOLA",
        "first_name": "KASSANDRA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-27",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474579189001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Christopher Jagoda, MD, MS
• James Skylar O'Brien, DDS, LLC
• Joel Janyia
• Bhavya Jasthi, DMD
• Darvin J Javier, M.D.
• Tierrha C Jefferson
• Loretta Jean Jendryka, LCPC
• Cathy Susan Jerousek
• Jessica Jimenez, MHP, BA
• JLS Counseling PLLC

• Clinical Social Worker in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.