Krystal Marie Fowlkes, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.026918 Issued in IL

Practice address

2948 Artesian Rd Ste 112
Naperville, IL 60564-8559

Phone

(630) 884-9073

NPI assigned

Apr 25, 2024

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: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Life Made Krystal Clear LLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1629817523
  NPD Authorized official
• Edgewood Clinical Services, P.C.

  • Community/Behavioral Health Agency
  • Naperville, IL
  • NPI 1366784837
  NPD (past)
• Psychology Specialists LTD

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)
• Cartwheel Health Services PC

  • Child & Adolescent Psychiatry Physician
  • Cambridge, MA
  • NPI 1912633975

  Clinical

  NPD (past)

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1891541470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 APPLEBY DR",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601898910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2948 ARTESIAN RD STE 112",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648559",
            "telephone_number": "630-884-9073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2045 W Grand Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606121577",
            "country_code": "US",
            "telephone_number": "312-933-3167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOWLKES",
        "first_name": "KRYSTAL",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foster Health PLLC
• Kelli Foster, RD
• Elizabeth Fotopoulos
• Foundation Foot and Ankle Center LLC
• Foundation Foot and Ankle Center LLC
• Fox Valley Foot Specialists,LTD
• Fox Valley Foot Specialists,LTD
• Fox Valley Imaging Center, Inc.
• Fox Valley Institute for Growth and Wellness Inc
• Fox Valley Laser Center

• Clinical Social Worker in Naperville, IL
• Providers in Naperville, 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 7, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.