Individual provider Active NPI

Jessica Roeder, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1679308928
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149021276 Issued in IL
Practice address
2019 N Sawyer Ave Apt 2F
Chicago, IL 60647-5170
Phone
(773) 744-3024
NPI assigned
Sep 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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 149021276 IL Primary

Addresses

Primary practice location

2019 N Sawyer Ave Apt 2F
Chicago, IL 60647-5170

Mailing address

2019 N Sawyer Ave Apt 2F
Chicago, IL 60647-5170
Phone (773) 744-3024

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

State licenses

LicenseStateTypeSpecialty
149021276ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jessica Roeder LCSW PLLC Clinical CurrentSince Sep 15, 2024 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1679308928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 N SAWYER AVE APT 2F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475170",
            "telephone_number": "773-744-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 N SAWYER AVE APT 2F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475170",
            "telephone_number": "773-744-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.