Kimberly N Spencer, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180009432 Issued in IL

Practice address

16939 Woodlawn East Ave
South Holland, IL 60473-3189

Phone

(773) 719-0523

NPI assigned

Mar 31, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thriveworks Clinical - IllinoisGroup PAC ID 6800263823, 45 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.

• Thriveworks Clinical - Illinois

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1164190633
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  IL, Professional

  Medicare reassignment NPD

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1437787876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16939 WOODLAWN EAST AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604733189",
            "telephone_number": "773-719-0523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16939 WOODLAWN EAST AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604733189",
            "telephone_number": "773-719-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "KIMBERLY",
        "middle_name": "N",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180009432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Park Pediatrics, Inc
• South Suburban Physical Therapy LTD
• Southwest Community Services, Inc.
• Southwest Community Services, Inc.
• Glendolyn Spencer
• St Margaret Mercy Healthcare Centers, Inc.
• Miriam Standberry-Sanders
• Miranda Standberry-Wallace
• Herman L Standberry
• Myra D Staples, LCSW

• Professional Counselor in South Holland, IL
• Providers in South Holland, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.