Active NPI
Kristen Clarke, MSW
- Clinical Social Worker
- Joliet, IL
National Provider Identifier
1750698684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-013778
- Practice address
- 300 Republic Ave
Joliet, IL 60435-6520 - Phone
- (815) 725-1440
- Fax
- (815) 725-1550
- NPI assigned
- Sep 14, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149-013778 | IL | Primary |
Addresses
Primary practice location
300 Republic Ave
Joliet, IL 60435-6520
Mailing address
1733 S la Londe Ave
Lombard, IL 60148-3500
Phone (815) 725-1440
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
| License | State | Type | Specialty |
|---|---|---|---|
| 149-013778 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284422400000",
"number": "1750698684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1733 S LA LONDE AVE",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601483500",
"telephone_number": "815-725-1440",
"fax_number": "815-725-1550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 REPUBLIC AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604356520",
"telephone_number": "815-725-1440",
"fax_number": "815-725-1550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "KRISTEN",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-14",
"last_updated": "2010-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-013778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.