Individual provider Active NPI

Joanne Simon Kestnbaum, LCSW

  • Clinical Social Worker
  • Skokie, IL
National Provider Identifier
1710996053
Registry record updated Apr 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149-001566 Issued in IL
Practice address
5225 Old Orchard Rd Ste 29
Skokie, IL 60077-1027
Phone
(847) 899-2911
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2019

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 149-001566 IL Primary

Addresses

Primary practice location

5225 Old Orchard Rd Ste 29
Skokie, IL 60077-1027

Mailing address

9021 Lincolnwood Dr
Evanston, IL 60203-1824
Phone (847) 899-2911

Other identifiers 1

IdentifierTypeStateIssuer
149-001566OtherILSTATE LICENSURE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
149-001566ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1710996053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9021 LINCOLNWOOD DR",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602031824",
            "telephone_number": "847-899-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 OLD ORCHARD RD STE 29",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771027",
            "telephone_number": "847-899-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTNBAUM",
        "first_name": "JOANNE",
        "middle_name": "SIMON",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-001566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE",
            "identifier": "149-001566",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.