Kirstie Ruckoldt, LCSW
Individual provider Active NPI Clinical Social Worker · Elburn, IL
NPI 1508728478 · NPPES record last updated Dec 1, 2025
Key facts
- NPI
- 1508728478
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.026470 (IL)
- Practice address
- 21 S Main St Unit a
Elburn, IL 60119-9194 - Phone
- (217) 471-4229
- NPI assigned
- Dec 1, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
149 Swanson Rd
Sycamore, IL 60178-1117
21 S Main St
Unit a
Elburn, IL 60119-9194
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260211001462 | IL | Practitioner - Clinical Social Worker | 0042799868 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.026470 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modus Operandi LLC | Current |
Accepting new patients |
Locations
21 S Main St
Unit A
Elburn, IL 60119
Phone (217) 471-4229
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.026470 | IL | Yes |
Addresses
Primary practice location
21 S Main St Unit a
Elburn, IL 60119-9194
Mailing address
21 S Main St Unit a
Elburn, IL 60119-9194
Other providers in Elburn, IL
- Prairie Valley Dental, P.C.
- Airianna Quintanilla
- Andrea Rauch
- Karen Frances Rink
- Robert B Davidson DDS PC
- Jean Ryan-Meyers
- Kristy Saar
- Michael James Schuiling
- Self Made Art Therapy LLC
- Shamrock RX, Inc.
All providers in Elburn, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.