Individual provider Active NPI

Rosario Maria Eliza Wangerin, MA

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1568945814
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180010832 Issued in IL
Practice address
6753 N Newgard Ave
Chicago, IL 60626-4279
Phone
(847) 902-8429
NPI assigned
Sep 12, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 180010832 IL
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180010832 IL Primary

Addresses

Primary practice location

6753 N Newgard Ave
Chicago, IL 60626-4279

Mailing address

6753 N Newgard Ave
Chicago, IL 60626-4279
Phone (847) 902-8429

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jun 23, 2024 through Jun 23, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
180010832ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Live Oak, Inc. Past Accepting new patients

Organizations & group practices 1

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": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1568945814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6753 N NEWGARD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264279",
            "telephone_number": "847-902-8429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6753 N NEWGARD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264279",
            "telephone_number": "847-902-8429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANGERIN",
        "first_name": "ROSARIO MARIA ELIZA",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "180010832",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180010832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.