Individual provider Active NPI

Layne Kirch, LCSW

  • Clinical Social Worker
  • St Charles, IL
National Provider Identifier
1790133056
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149024688 Issued in IL
Practice address
111 E Main St
St Charles, IL 60174-1948
Phone
(630) 587-3777
NPI assigned
May 27, 2016
Last updated
Jun 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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 149024688 IL Primary

Addresses

Primary practice location

111 E Main St
St Charles, IL 60174-1948

Mailing address

PO Box 1109
Dekalb, IL 60115-7109
Phone (815) 756-4875

Other identifiers 1

IdentifierTypeStateIssuer
474579189001MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149024688ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1790133056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1109",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601157109",
            "telephone_number": "815-756-4875",
            "fax_number": "815-756-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E MAIN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741948",
            "telephone_number": "630-587-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRCH",
        "first_name": "LAYNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-27",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149024688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474579189001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

Verify at the official NPI Registry.