Kelly Ann Vatianou, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149018287 Issued in IL

Practice address

76 S Main St
#B
Sugar Grove, IL 60554-5023

Phone

(630) 466-8657

NPI assigned

Aug 8, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1750835716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 S MAIN ST",
            "address_2": "#B",
            "city": "SUGAR GROVE",
            "state": "IL",
            "postal_code": "605545023",
            "telephone_number": "630-466-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 S MAIN ST",
            "address_2": "#B",
            "city": "SUGAR GROVE",
            "state": "IL",
            "postal_code": "605545023",
            "telephone_number": "630-466-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VATIANOU",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "15009806",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Walgreen Co
• Walgreen Co.

• Clinical Social Worker in Sugar Grove, IL
• Providers in Sugar Grove, 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 Aug 8, 2016; 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.