Kelly Derr, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149016583 Issued in IL

Practice address

9435 Bormet Dr Ste 5
Mokena, IL 60448-7401

Phone

(708) 995-7226

NPI assigned

Mar 31, 2019

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

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

{
    "created_epoch": "1553990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553990400000",
    "number": "1912468927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N BROADWAY ST",
            "city": "COAL CITY",
            "state": "IL",
            "postal_code": "604161044",
            "telephone_number": "815-584-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9435 BORMET DR STE 5",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604487401",
            "telephone_number": "708-995-7226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERR",
        "first_name": "KELLY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-31",
        "last_updated": "2019-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149016583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Remy Demaertelaere, DO
• Molly Demereckis, BCBA
• Dental Professionals of Illinois, P.C.
• Kelly Kathleen Devereux, M.S. CCC-SLP
• Kelly L Devine, MS, RDN, LDN
• Jeffrey Brian Devries, L.C.S.W.
• Julie Elizabeth Di Novo, FNP
• Diagnostic P.E.T. Network, LLC

• Clinical Social Worker in Mokena, IL
• Providers in Mokena, 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 Mar 31, 2019; 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.