Elise Joelle Johnston Dumerauf

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149023033 Issued in IL

Practice address

3620 Wesley Ave
Berwyn, IL 60402-3861

Phone

(162) 128-9576

NPI assigned

Aug 29, 2018

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

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

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wild Fern Clinical Therapy PLLC

  • Clinical Social Worker
  • Berwyn, IL
  • NPI 1346084829
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1508348343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 WESLEY AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 WESLEY AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023861",
            "telephone_number": "162-128-9576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON DUMERAUF",
        "first_name": "ELISE",
        "middle_name": "JOELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149023033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alma Leticia Jimenez Tapia, LCSW
• Anna Rosa Jimenez, LCSW
• Paul John
• Linda Inez Johnson
• Sara Johnson, M.D.
• Jonathan Oh DDS PLLC
• John W Jones
• Tamajah Marie Jordan, M.D.
• Mira Jovic
• Jenelle Joyce

• Clinical Social Worker in Berwyn, IL
• Providers in Berwyn, 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 Oct 16, 2024; 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.