Mrs Kerrie Danielle Fish, LCSW, CADC is a medicare enrolled "Social Worker - Clinical" provider in Waukegan, Illinois. Her current practice location is
3004 Grand Ave, Waukegan, Illinois. You can reach out to her office (for appointments etc.) via phone at
(847) 377-8120.
Mrs Kerrie Danielle Fish is licensed to practice in Illinois (license number 149.017900) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1669730198.
Healthcare Provider's Profile
| Full Name | Mrs Kerrie Danielle Fish |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3004 Grand Ave, Waukegan, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1669730198
- Provider Enumeration Date: 05/03/2012
- Last Update Date: 02/20/2020
Medicare PECOS Information:
- PECOS PAC ID: 0345572855
- Enrollment ID: I20191104000746
Medical Identifiers
Medical identifiers for Mrs Kerrie Danielle Fish such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1669730198 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 30977 (Illinois) | Secondary |
| 1041C0700X | Social Worker - Clinical | 149.017900 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Kerrie Danielle Fish allows following entities to bill medicare on her behalf.
| Entity Name | County Of Lake |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1164446712
PECOS PAC ID: 7214838861
Enrollment ID: O20040116000192 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kerrie Danielle Fish is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mrs Kerrie Danielle Fish, LCSW, CADC
3010 Grand Ave,
Waukegan, IL 60085-2321
Ph: (847) 377-8120 | Mrs Kerrie Danielle Fish, LCSW, CADC
3004 Grand Ave,
Waukegan, IL 60085-2321
Ph: (847) 377-8120 |
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