Kristina Bergles – Clinical Social Worker

Key facts

NPI: 1578057360
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 149013551 (IL)
Practice address: 855 E Palatine Rd Ste 250
Palatine, IL 60074-5500
Phone: (847) 504-9521
NPI assigned: Jun 15, 2018
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
22858	IL	MD	Addiction (Substance Use Disorder) Counselor
149013551	IL	MD	Clinical Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) Counselor	101YA0400X	22858	IL
Clinical Social Worker	1041C0700X	149013551	IL	Yes

Addresses

Primary practice location

855 E Palatine Rd Ste 250
Palatine, IL 60074-5500

Mailing address

855 E Palatine Rd Ste 250
Palatine, IL 60074-5500

Other identifiers

Identifier	Type	State	Issuer
46-1967210	Medicaid	IL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 6, 2019.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1578057360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 E PALATINE RD STE 250",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600745500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 E PALATINE RD STE 250",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600745500",
            "telephone_number": "847-504-9521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGLES",
        "first_name": "KRISTINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "22858",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46-1967210",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palatine, IL

All providers in Palatine, 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 May 6, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.