Brian D. Gazdziak, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149016018 Issued in IL

Practice address

100 Stahlhut Dr
Lincoln, IL 62656-5059

Phone

(217) 735-9555

NPI assigned

Sep 18, 2013

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: brian.gazdziak.1@28977.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 22, 2020.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1447686704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541",
            "fax_number": "217-528-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STAHLHUT DR",
            "city": "LINCOLN",
            "state": "IL",
            "postal_code": "626565059",
            "telephone_number": "217-735-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAZDZIAK",
        "first_name": "BRIAN",
        "middle_name": "D.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-18",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149016018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "briangazdziak@sfc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "100 Stahlhut Dr",
            "city": "Lincoln",
            "state": "IL",
            "country_code": "US",
            "postal_code": "626565059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Lincoln, IL
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.

Verify at the official NPI Registry.