Individual provider Active NPI

Shelly Ailene Quiles, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1821633249
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.021766 Issued in IL
Practice address
6720 S Dorchester Ave
Chicago, IL 60637-4713
Phone
(773) 621-3670
NPI assigned
Nov 8, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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 149.021766 IL Primary

Addresses

Primary practice location

6720 S Dorchester Ave
Chicago, IL 60637-4713

Mailing address

6720 S Dorchester Ave
Chicago, IL 60637-4713
Phone (773) 621-3670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.021766ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1821633249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 S DORCHESTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606374713",
            "telephone_number": "773-621-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 S DORCHESTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606374713",
            "telephone_number": "773-621-3670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUILES",
        "first_name": "SHELLY",
        "middle_name": "AILENE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-08",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.