Active NPI
Amanda Ray Elliott, LCSW
- Social Worker
- Park Ridge, IL
National Provider Identifier
1922324342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 1580 N Northwest Hwy
Unit 215
Park Ridge, IL 60068-1444 - Phone
- (847) 299-3400
- NPI assigned
- Apr 9, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
1580 N Northwest Hwy
Unit 215
Park Ridge, IL 60068-1444
Mailing address
1211 Evergreen Ave
Des Plaines, IL 60016
Phone (773) 699-8868
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 475 | Medicaid | IL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432771200000",
"number": "1922324342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 EVERGREEN AVE",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "60016",
"telephone_number": "773-699-8868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 N NORTHWEST HWY",
"address_2": "UNIT 215",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681444",
"telephone_number": "847-299-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "AMANDA",
"middle_name": "RAY",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-09",
"last_updated": "2015-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "475",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.