Jennifer R. Koranyi
Individual provider Active NPI Clinical Social Worker · Dorsey, IL
NPI 1780126532 · NPPES record last updated Oct 22, 2024
Key facts
- NPI
- 1780126532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.024164 (IL)
- Practice address
- 8453 S Schiller St
Dorsey, IL 62021-1807 - Phone
- (618) 417-7126
- NPI assigned
- Nov 10, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
130 Parkview Rd
Stratford, NJ 08084-1822
8453 S Schiller St
Dorsey, IL 62021-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190809003068 | KY | Practitioner - Clinical Social Worker | 6406183680 | Reassigns benefits to 1 organization |
| I20260608001062 | IL | Practitioner - Clinical Social Worker | 6406183680 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.024164 | IL | MD | Clinical Social Worker |
| 254266 | KY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeskills, Inc. | Current |
Accepting new patients | |
| Leaning Fence Therapy Center, LLC | Clinical | Current |
Accepting new patients |
Locations
8324 Eagle Way
Chicago, IL 60678
608 Happy Valley Rd
Glasgow, KY 42141
Phone (270) 651-8379
735 North Dr
Hopkinsville, KY 42240
Phone (270) 886-5163
737B North Dr
Hopkinsville, KY 42240
Phone (270) 881-9551
607 Hammond Plz
Hopkinsville, KY 42240
Phone (270) 881-9551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 254266 | KY | |
| Clinical Social Worker | 1041C0700X | 149.024164 | IL | Yes |
Addresses
Primary practice location
8453 S Schiller St
Dorsey, IL 62021-1807
Mailing address
PO Box 614
Hopkinsville, KY 42241-0614
Phone (270) 886-2205
Other practice location 1
735 North Dr
Hopkinsville, KY 42240-2620
Phone (270) 886-5163
Other practice location 2
737B North Dr
Hopkinsville, KY 42240
Phone (270) 890-1780
Other names
- Jennifer Short
Other providers in Dorsey, IL
- Leaning Fence Therapy Center, LLC
- Laura Elizabeth Maher
- Kimberly Ann Murphy
- Playful Start Therapy, LLC.
- Christine Marlene Stark
All providers in Dorsey, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.