Individual provider Active NPI

Sandra Jay Zeidler, MSW LCSW

  • Clinical Social Worker
  • Villa Park, IL
National Provider Identifier
1477606895
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
250 E Saint Charles Road
Villa Park, IL 60181
Phone
(630) 833-4022
Fax
(630) 833-4011
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X IL Primary

Addresses

Primary practice location

250 E Saint Charles Road
Villa Park, IL 60181

Mailing address

250 E Saint Charles Road
Villa Park, IL 60181
Phone (630) 833-4022

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

LicenseStateTypeSpecialty
149004624ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477606895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E SAINT CHARLES ROAD",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "60181",
            "telephone_number": "630-833-4022",
            "fax_number": "630-833-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E SAINT CHARLES ROAD",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "60181",
            "telephone_number": "630-833-4022",
            "fax_number": "630-833-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEIDLER",
        "first_name": "SANDRA",
        "middle_name": "JAY",
        "name_prefix": "Miss",
        "credential": "MSW LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.