Individual provider Active NPI

Kelly M Ratajczak, LCSW

  • Clinical Social Worker
  • Antioch, IL
National Provider Identifier
1962131318
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.010985 Issued in IL
Practice address
311 W Depot St Ste M
Antioch, IL 60002-1500
Phone
(331) 725-1190
NPI assigned
Jun 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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 149.010985 IL Primary

Addresses

Primary practice location

311 W Depot St Ste M
Antioch, IL 60002-1500

Mailing address

2212 Green Glade Way
Wauconda, IL 60084-5027
Phone (121) 991-6622

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

LicenseStateTypeSpecialty
149.010985ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
New Leaf Counseling Clinical CurrentSince Jun 15, 2025 Accepting new patients

Locations

311 W Depot St
Ste M
Antioch, IL 60002
Phone (331) 725-1190

Organizations & group practices 1

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": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1962131318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2212 GREEN GLADE WAY",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600845027",
            "telephone_number": "121-991-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W DEPOT ST STE M",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021500",
            "telephone_number": "331-725-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATAJCZAK",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.