Individual provider Active NPI

Kathleen M Niesen Zucchi, LCSW

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1750995437
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.008068 Issued in IL
Practice address
631 N Longwood St Ste 103
Rockford, IL 61107-4263
Phone
(815) 962-5585
NPI assigned
Sep 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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 149.008068 IL Primary

Addresses

Primary practice location

631 N Longwood St Ste 103
Rockford, IL 61107-4263

Mailing address

631 N Longwood St Ste 103
Rockford, IL 61107-4263
Phone (815) 962-5585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260511001870 IL Practitioner - Clinical Social Worker 9537637236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5844 Elaine Dr
Suite 103
Rockford, IL 61108-2494

631 N Longwood St
Suite 103
Rockford, IL 61107-4263

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.008068ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Counseling Services of Northern Illinois Clinical CurrentSince Sep 6, 2020 Accepting new patients

Locations

631 N Longwood St
Ste 103
Rockford, IL 61107
Phone (815) 962-5585

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": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1750995437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N LONGWOOD ST STE 103",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074263",
            "telephone_number": "815-962-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N LONGWOOD ST STE 103",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074263",
            "telephone_number": "815-962-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIESEN ZUCCHI",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.008068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.