Radicallyblended Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

RADICALLYBLENDED SERVICES

Practice address

5113 S Harper Ave Ste 2C
Chicago, IL 60615-4119

Phone

(872) 763-4405

NPI assigned

Jun 13, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keisha J Walker Mathew, LCSWNPI 1962157248

Title

Owner

Phone

(872) 763-4405

Specialties & licenses 1

Addresses

Other names 1

• radicallyBLended Services Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keisha Janay Walker-Mathew, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1962157248
  NPD Authorized official

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1932942497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5113 S HARPER AVE STE 2C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154119",
            "telephone_number": "872-763-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5113 S HARPER AVE STE 2C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154119",
            "telephone_number": "872-763-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADICALLYBLENDED SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "WALKER MATHEW",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "872-763-4405",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "radicallyBLended Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Radiant Health Care Inc.
• Radical Authenticity & Wellness Psychotherapy Group LLC
• Radical Healing Psychotherapy PLLC
• Radical Realness Therapy PLLC
• Radical Resilience, LLC
• George A Radich, MD
• Kimberly Radich, MS, RD, LDN
• Kathryn Radigan, M.D.
• Samantha Rose Radinsky
• Radiological Physicians, LTD.

• 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 Nov 14, 2024; 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.