Individual provider Active NPI

Kathleen O Retzner, LCSW

  • Clinical Social Worker
  • Wheaton, IL
National Provider Identifier
1942519160
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.013111 Issued in IL
Practice address
2100 Manchester Rd
Suite 1510
Wheaton, IL 60187-4579
Phone
(630) 653-1717
Fax
(630) 653-9691
NPI assigned
Oct 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.013111 IL Primary

Addresses

Primary practice location

2100 Manchester Rd
Suite 1510
Wheaton, IL 60187-4579

Mailing address

2100 Manchester Rd
Suite 1510
Wheaton, IL 60187-4579
Phone (630) 653-1717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110316000543 IL Practitioner - Clinical Social Worker 3274715990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grace Integrated LLCGroup PAC ID 7911272901, 18 clinicians

Practice addresses (Care Compare)

125 Windsor Dr
Suite 113
Oak Brook, IL 60523-4082
Phone (630) 728-1744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.013111ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Integrated, LLC CurrentSince Mar 1, 2022 Accepting new patients
Meier Clinics of Illinois, P.C. Clinical Past Accepting new patients

Locations

2500 S Highland Ave
Ste 325
Lombard, IL 60148
Phone (630) 495-9810

125 Windsor Dr
Ste 113
Oak Brook, IL 60523
Phone (630) 728-1744

414 Plaza Dr
Ste 301
Westmont, IL 60559
Phone (630) 728-1744

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286236800000",
    "number": "1942519160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MANCHESTER RD",
            "address_2": "SUITE 1510",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601874579",
            "telephone_number": "630-653-1717",
            "fax_number": "630-653-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MANCHESTER RD",
            "address_2": "SUITE 1510",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601874579",
            "telephone_number": "630-653-1717",
            "fax_number": "630-653-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETZNER",
        "first_name": "KATHLEEN",
        "middle_name": "O",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.013111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.