Individual provider Active NPI

Kristen C Speagle, LCSW

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1952809741
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SWI.LW.70098290 Issued in WA
Practice address
1802 S Mattis Ave
Champaign, IL 61821-5923
Phone
(217) 365-2855
Fax
(217) 365-2856
NPI assigned
Jan 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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 SWI.LW.70098290 WA Primary

Addresses

Primary practice location

1802 S Mattis Ave
Champaign, IL 61821-5923

Mailing address

611 W Park St
Urbana, IL 61801-2501
Phone (217) 383-3311

Other practice location 1

2125 S Neil St
Champaign, IL 61820-7266
Phone (217) 352-0200

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
I20221115002024 IL Practitioner - Clinical Social Worker 4880062355 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 326-1330

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SWI.LW.70098290WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince Dec 14, 2025 Accepting new patients
Keri Powell Therapy Inc Mental Health CurrentSince May 24, 2023 Accepting new patients

Locations

2125 S Neil St
Champaign, IL 61820
Phone (217) 356-3736

1802 S Mattis Ave
Champaign, IL 61821
Phone (217) 365-2855

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

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": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1952809741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501",
            "telephone_number": "217-383-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 S MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215923",
            "telephone_number": "217-365-2855",
            "fax_number": "217-365-2856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2125 S Neil St",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618207266",
            "country_code": "US",
            "telephone_number": "217-352-0200",
            "fax_number": "217-607-1139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEAGLE",
        "first_name": "KRISTEN",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SWI.LW.70098290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.