Jennifer Costello, LCSW, RD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149020773 Issued in IL

Practice address

6601 North Ave
Oak Park, IL 60302

Phone

(708) 831-2122

NPI assigned

Mar 20, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Embody Therapy

  • Clinical Social Worker
  • Pittsburgh, PA
  • NPI 1487422382
  NPD Authorized official

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1659798205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 NORTH AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021005",
            "telephone_number": "708-831-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 NORTH AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60302",
            "telephone_number": "708-831-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1235 SE Morrison St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972142462",
            "country_code": "US",
            "telephone_number": "503-376-7114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "JENNIFER",
        "credential": "LCSW, RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6842",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW018565",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LDD10176233",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149020773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackeline Cortez
• Patricia Cortez
• Heather Lea Corwin, PHD, LPC, RME, MFA
• Marques Cosby Sr., LCSW
• Chanel Mulan Cosey
• Sarah Katherine Costianis, DC
• Daniel Lawrence Cotter, MD
• Donna Lee Cotton, PSY.D., LCPC
• Barbara Wynn Coughlin, LCSW, CADC
• Nicole Anne Coughlin, DPT

• Clinical Social Worker in Oak Park, IL
• Providers in Oak Park, 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 Jul 21, 2022; 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.