Active NPI
Kaitlyn Blackburn, LSW
- Social Worker
- Mokena, IL
National Provider Identifier
1508516097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150107183
- Practice address
- 18700 Wolf Rd Ste 209
Mokena, IL 60448-8699 - Phone
- (779) 707-3717
- NPI assigned
- Mar 27, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 150107183 | IL | Primary |
Addresses
Primary practice location
18700 Wolf Rd Ste 209
Mokena, IL 60448-8699
Mailing address
18700 Wolf Rd Ste 209
Mokena, IL 60448-8699
Phone (779) 707-3717
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 |
|---|---|---|---|
| 150107183 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648339200000",
"number": "1508516097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18700 WOLF RD STE 209",
"city": "MOKENA",
"state": "IL",
"postal_code": "604488699",
"telephone_number": "779-707-3717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18700 WOLF RD STE 209",
"city": "MOKENA",
"state": "IL",
"postal_code": "604488699",
"telephone_number": "779-707-3717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "KAITLYN",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-27",
"last_updated": "2022-03-27",
"certification_date": "2022-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150107183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.