Active NPI
Peter Illing, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1922201813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-004066
- Practice address
- 4101 N Ravenswood Ave
Chicago, IL 60613-2193 - Phone
- (773) 572-5500
- NPI assigned
- Jun 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149-004066 | IL | Primary |
Addresses
Primary practice location
4101 N Ravenswood Ave
Chicago, IL 60613-2193
Mailing address
4101 N Ravenswood Ave
Chicago, IL 60613-2193
Phone (773) 572-5500
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-004066 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1922201813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 N RAVENSWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132193",
"telephone_number": "773-572-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 N RAVENSWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132193",
"telephone_number": "773-572-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLING",
"first_name": "PETER",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-07",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-004066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
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- Elif Nisan Ilkmen, AMFT
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- Illiana Physicians Group
- Leslie Joel Illidge
- Elizabeth Illingworth, LCSW
- Illinois ABA Therapy LLC
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- Illinois Anesthesia Specialists LLC
- Illinois Applied Behavior Analysis LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.