Individual provider Active NPI

Haily Nicole Lipps, MSW, LCSW

  • Clinical Social Worker
  • Washington, IL
National Provider Identifier
1538910971
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.026925 Issued in IL
Practice address
1008 Miller St
Washington, IL 61571-1629
Phone
(309) 215-2341
NPI assigned
Apr 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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 149.026925 IL Primary

Addresses

Primary practice location

1008 Miller St
Washington, IL 61571-1629

Mailing address

1008 Miller St
Washington, IL 61571-1629
Phone (309) 215-2341

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240618000165 IL Practitioner - Clinical Social Worker 3971046061

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2200 Fort Jesse Rd
Suite 220
Normal, IL 61761-6286

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.026925ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Graham & Grace Counseling Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Apr 30, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

2200 Fort Jesse Rd
Ste 220
Normal, IL 61761
Phone (309) 664-3130

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1538910971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 MILLER ST",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615711629",
            "telephone_number": "309-215-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MILLER ST",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615711629",
            "telephone_number": "309-215-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPPS",
        "first_name": "HAILY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, IL

Sources for this page

Verify at the official NPI Registry.