Active NPI
Andrea Tack
- Social Worker
- Rockford, IL
National Provider Identifier
1447706296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.015410
- Practice address
- 3690 Laura LN
Rockford, IL 61114-8179 - Phone
- (815) 520-4145
- NPI assigned
- Aug 31, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.015410 | IL | Primary |
Addresses
Primary practice location
3690 Laura LN
Rockford, IL 61114-8179
Mailing address
123456 Main Street
Rockford, IL 61114-8179
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.015410 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498780800000",
"number": "1447706296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123456 MAIN STREET",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611148179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3690 LAURA LN",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611148179",
"telephone_number": "815-520-4145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACK",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-31",
"last_updated": "2017-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.015410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.