Marissa Kirch, LCSW, CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.017161 Issued in IL

Practice address

12 Health Services Dr
Dekalb, IL 60115-9637

Phone

(630) 414-3394

NPI assigned

Mar 9, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Stonybrook Center

  • Clinic/Center
  • Wheaton, IL
  • NPI 1629374566
  NPD (past)

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1639562101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1109",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601157109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 HEALTH SERVICES DR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159637",
            "telephone_number": "630-414-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRCH",
        "first_name": "MARISSA",
        "name_prefix": "Miss",
        "credential": "LCSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-09",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "32235",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Eugene Kerr III, ATC
• Shaan Keswani
• Danielle Michelle Keys, LPC
• Ghori Siddique Rashio Khan, MD
• In-Sop Kim
• Hunter Kirkland
• Kishhealth System
• Kishwaukee Community Health Services Center (Kishwaukee Community Hospital)
• Kishwaukee Community Hospital (Kishwaukee Community Hospital Pharmacy)
• Kishwaukee Community Hospital (Northwestern Medicine Kishwaukee Hospital)

• Clinical Social Worker in Dekalb, IL
• Providers in Dekalb, 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 Jan 15, 2020; 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.