Kelly King-Holliday

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.015786 Issued in IL

Practice address

1921 S Indiana Ave
Chicago, IL 60616-5819

Phone

(312) 328-2268

NPI assigned

Sep 10, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Guided Bloom

  • Clinical Social Worker
  • Homewood, IL
  • NPI 1306702600
  NPD Authorized official

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613174400000",
    "number": "1831704436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 S INDIANA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606165819",
            "telephone_number": "312-328-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 S INDIANA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606165819",
            "telephone_number": "312-328-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING-HOLLIDAY",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2021-02-13",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.015786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kellykingholliday.com",
            "affiliation": "N",
            "address_1": "17212 Central Park Ave",
            "city": "Hazel Crest",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604291506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• King Health Services, Inc.
• King I LTD
• King Nursing LLC
• Jennifer A King Pappas, MHS
• Alicia King-Booker
• Joya King-Hooks, MSW
• Rashida King-Lynch
• Cynthia King-Myers, LCSW
• Jacqueline King-Papadopoulos, LCSW
• Aaron M. King, M.D.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Feb 13, 2021; 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.