Kathryn Kelly Carroll, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.016164 Issued in IL

Practice address

1645 W Jackson Blvd
Ste 302
Chicago, IL 60612-3276

Phone

(608) 438-8865

NPI assigned

Aug 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Kathryn Kelly Bulla Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Rush University Medical Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542
  NPD (past)

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1992999114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "STE 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121336",
            "telephone_number": "312-563-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "STE 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "608-438-8865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "KATHRYN",
        "middle_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.016164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "BULLA",
            "middle_name": "KELLY",
            "prefix": "MISS",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin Carroll, LPC
• Jodi Lee Carroll, MS OTR/L
• Julia Carroll, OTR/L
• Kaelyn Carroll, RN, CNM
• Katherine Carroll, M.D.
• Kylie Kathleen Carroll, OTR/L
• Laurie Gold Carroll, DPT
• Mary K Carroll
• Mary Katherine Carroll, DNP, APRN, FNP-BC
• Nicole Carroll

• 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 Jun 6, 2017; 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.