Mignon Pruitt

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149006136 Issued in IL

Practice address

741 East 75TH Street
Chicago, IL 60619-1928

Phone

(773) 891-3242

Fax

(312) 874-7219

NPI assigned

Sep 1, 2016

Last updated

Sep 11, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473552000000",
    "number": "1578019204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17125 BERNADINE STREET",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381473",
            "telephone_number": "773-671-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 EAST 75TH STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606191928",
            "telephone_number": "773-891-3242",
            "fax_number": "312-874-7219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "MIGNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "149006136",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149006136",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149006136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1326447020",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee Pruente, LPC
• Taylor Pruett, LCSW
• Gladys Pruitt-Lang
• Coretta J Pruitt
• Jamesa Pruitt
• Nayesha Adia Pruitt, LPC
• Nikiya Pruitt
• Peter Burton Pruitt, M.D.
• Shervylle Pruitt
• Bozena Prus, PA

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Sep 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.