Unknown Individual – Clinical Social Worker, NPI 1417021197

Unknown Individual is a healthcare provider. based in Herrin, Illinois. specializing in Clinical Social Worker. They hold a License No. 149-000011 (IL). The NPI Number for Unknown Individual is 1417021197

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417021197
Phone
(618) 988-1757
Address
1220 S PARK AVE
Deactivation Date
12 October 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1220, South Park Avenue, Herrin, Williamson County, Illinois, 62948, United States

    HERRIN, IL 629484128

    Phone: (618) 988-1757

    Fax: (618) 988-1700

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 62948)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1417021197 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Herrin, Illinois as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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