Individual provider Active NPI

Katie Wooldridge

  • Clinical Social Worker
  • Alton, IL
National Provider Identifier
1689493827
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.026224 Issued in IL
Practice address
515 E 10TH St
Alton, IL 62002-3624
Phone
(618) 954-8119
NPI assigned
Oct 4, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 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 149.026224 IL Primary

Addresses

Primary practice location

515 E 10TH St
Alton, IL 62002-3624

Mailing address

515 E 10TH St
Alton, IL 62002-3624
Phone (618) 954-8119

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
149.026224ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1689493827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E 10TH ST",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620023624",
            "telephone_number": "618-954-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E 10TH ST",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620023624",
            "telephone_number": "618-954-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOLDRIDGE",
        "first_name": "KATIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-04",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.