Individual provider Active NPI

Cody Elizabeth Martin, LCSW

  • Clinical Social Worker
  • West Peoria, IL
National Provider Identifier
1649645110
Registry record updated Jun 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.031934 Issued in IL
Practice address
3000 W Rohmann Ave
West Peoria, IL 61604-4842
Phone
(309) 671-0300
NPI assigned
Dec 9, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2026

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 149.031934 IL Primary

Addresses

Primary practice location

3000 W Rohmann Ave
West Peoria, IL 61604-4842

Mailing address

4704 N Edgebrook Dr
Peoria, IL 61614-6014
Phone (309) 892-0243

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782000000000",
    "number": "1649645110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4704 N EDGEBROOK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146014",
            "telephone_number": "309-892-0243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 W ROHMANN AVE",
            "city": "WEST PEORIA",
            "state": "IL",
            "postal_code": "616044842",
            "telephone_number": "309-671-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CODY",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-09",
        "last_updated": "2026-06-21",
        "certification_date": "2026-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.031934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2026; 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.