Kathleen Marie O'Dierno, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018745 Issued in IL

Practice address

129 Phelps Ave Ste 1005
Rockford, IL 61108-2456

Phone

(815) 200-4966

Fax

(815) 935-2429

NPI assigned

Sep 24, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 11, 2019 through Nov 11, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1474675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787961600000",
    "number": "1760931356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 PHELPS AVE STE 1005",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082456",
            "telephone_number": "815-200-4966",
            "fax_number": "815-935-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 PHELPS AVE STE 1005",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082456",
            "telephone_number": "815-200-4966",
            "fax_number": "815-935-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DIERNO",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-24",
        "last_updated": "2026-08-29",
        "certification_date": "2026-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca J Nygren, P.T., D.P.T.
• Scott R Nyquist, MD
• John Andrew O'Brien, DDS
• Kaitlyn O'Brien, LPC
• Heather Marie O'Connor
• Carol J O'Haron, LCSW
• Mary B O'Meara, FNP
• Nicole Ann O'Neill, RDN
• Ashley Nicole O'Reilly, D.M.D
• Linda Lou O'Reilly, COMS

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.