| Blue Moon Senior Counseling Of Illinois Llc | |
|
10204 Bode St Ste B Plainfield IL 60585-9813 | |
| (855) 241-7160 | |
| (954) 465-5142 |
| Full Name | Blue Moon Senior Counseling Of Illinois Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10204 Bode St Ste B, Plainfield, Illinois |
| Authorized Official Name and Position | Melanie Donohue (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8552417160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Moon Senior Counseling Of Illinois Llc 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 | Blue Moon Senior Counseling Of Illinois Llc 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 |
| NPI Number | 1841562931 |
|---|---|
| Provider Enumeration Date | 02/03/2012 |
| Last Update Date | 09/20/2019 |
| Medicare PECOS PAC ID | 7012172893 |
|---|---|
| Medicare Enrollment ID | O20120628000431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841562931 | NPI | - | NPPES |
| IL7187 | Other | IL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Yousuf Sayeed |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1932155926 PECOS PAC ID: 6901889823 Enrollment ID: I20040621001385 |
| Provider Name | Kimberlee A Kali-schultes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942371307 PECOS PAC ID: 9436114345 Enrollment ID: I20070516000043 |
| Provider Name | Donna Laluya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134260144 PECOS PAC ID: 6800951567 Enrollment ID: I20090211000819 |
| Provider Name | Marilyn J Ciaramitaro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194030551 PECOS PAC ID: 9032307418 Enrollment ID: I20101229000694 |
| Provider Name | Jennifer S Beckman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366735250 PECOS PAC ID: 0042498156 Enrollment ID: I20110620000509 |
| Provider Name | Anna Sarenac |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134491137 PECOS PAC ID: 2466616651 Enrollment ID: I20120620000329 |
| Provider Name | Rita M Conrad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538469226 PECOS PAC ID: 3870717648 Enrollment ID: I20140617002515 |
| Provider Name | Erika Czemerys Wackenhut |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619387800 PECOS PAC ID: 7517182033 Enrollment ID: I20140625001611 |
| Provider Name | Rosemary Frances Odmark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891190781 PECOS PAC ID: 9234451485 Enrollment ID: I20141125001905 |
| Provider Name | Joy Lee Pascoe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871997494 PECOS PAC ID: 5395069124 Enrollment ID: I20150126002044 |
| Provider Name | Donna Elizabeth Swanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215328190 PECOS PAC ID: 6709103666 Enrollment ID: I20150402001768 |
| Provider Name | Eileen A Myles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740576776 PECOS PAC ID: 9335467240 Enrollment ID: I20150406000056 |
| Provider Name | Victoria Duran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740672252 PECOS PAC ID: 7618295866 Enrollment ID: I20150420000236 |
| Provider Name | James Todd Boggess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902216849 PECOS PAC ID: 3274852322 Enrollment ID: I20150512001472 |
| Provider Name | Katrina M Dolle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497179667 PECOS PAC ID: 2961719257 Enrollment ID: I20150918001835 |
| Provider Name | Haley Swanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740418474 PECOS PAC ID: 0840580684 Enrollment ID: I20160607000251 |
| Provider Name | Haley J Grasso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902359110 PECOS PAC ID: 3274820907 Enrollment ID: I20160923001869 |
| Provider Name | Rocio Blas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265798748 PECOS PAC ID: 5395028716 Enrollment ID: I20170209001649 |
| Provider Name | Shermana Danielle Snow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316474448 PECOS PAC ID: 7719255868 Enrollment ID: I20170614002521 |
| Provider Name | Kristine H Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336679455 PECOS PAC ID: 6507139029 Enrollment ID: I20170906000056 |
| Provider Name | Elizabeth D Mcgarry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508291584 PECOS PAC ID: 3173882917 Enrollment ID: I20180124000442 |
| Provider Name | Dominika Ventucci |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558865741 PECOS PAC ID: 9234493354 Enrollment ID: I20180425002490 |
| Provider Name | Craig Fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437157351 PECOS PAC ID: 3870857857 Enrollment ID: I20180426002435 |
| Provider Name | Jose Malagon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437625183 PECOS PAC ID: 3476898248 Enrollment ID: I20181224000334 |
| Provider Name | Rachael Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427485952 PECOS PAC ID: 7315287281 Enrollment ID: I20190313001062 |
| Provider Name | Jennifer Unger Kroc |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912556671 PECOS PAC ID: 5496085052 Enrollment ID: I20190924002619 |
| Provider Name | Loren Jessica Havrilla |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376095364 PECOS PAC ID: 3577995661 Enrollment ID: I20191111002276 |
| Provider Name | Korey E James |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598079584 PECOS PAC ID: 8729410683 Enrollment ID: I20191114000285 |
| Provider Name | Angie N Whitfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467008425 PECOS PAC ID: 5496180366 Enrollment ID: I20200123000042 |
| Provider Name | Austin P Tyus-michalak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932748506 PECOS PAC ID: 1658706486 Enrollment ID: I20200124000050 |
| Provider Name | Julie Rakay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942820931 PECOS PAC ID: 6800217837 Enrollment ID: I20200530000204 |
| Provider Name | Mary Mims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174989016 PECOS PAC ID: 5496178204 Enrollment ID: I20200713002854 |
| Provider Name | Cynthia O'donnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124294137 PECOS PAC ID: 8022184324 Enrollment ID: I20200729002013 |
| Provider Name | Ciara Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740843176 PECOS PAC ID: 6002231693 Enrollment ID: I20200729003190 |
| Provider Name | Thomas Cicero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609492933 PECOS PAC ID: 5294150694 Enrollment ID: I20200801000006 |
| Provider Name | Erin Vondrasek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013342724 PECOS PAC ID: 1153732342 Enrollment ID: I20201118003322 |
| Provider Name | Kristin Joy Marcussen Loerop |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578159380 PECOS PAC ID: 6305820523 Enrollment ID: I20210226000643 |
| Provider Name | Amanda S Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962086744 PECOS PAC ID: 3274932777 Enrollment ID: I20210603002662 |
| Provider Name | Andrew Duckworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609476134 PECOS PAC ID: 2668878836 Enrollment ID: I20210914001077 |
| Provider Name | Abby G Barrett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053785675 PECOS PAC ID: 0547667594 Enrollment ID: I20210920000049 |
| Provider Name | Lisa Ann Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336816107 PECOS PAC ID: 3577961044 Enrollment ID: I20211013003197 |
| Provider Name | Mary Morrissette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457009185 PECOS PAC ID: 9335526870 Enrollment ID: I20220523000305 |
| Provider Name | Karen Clark Elliott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386399970 PECOS PAC ID: 8820467723 Enrollment ID: I20221216000087 |
| Provider Name | Sarah E Lamie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306023320 PECOS PAC ID: 1951771625 Enrollment ID: I20221221003259 |
| Provider Name | Margaret Virginia Haycraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447397393 PECOS PAC ID: 7911389309 Enrollment ID: I20230111001045 |
| Provider Name | Edward Jason Muldrow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851378814 PECOS PAC ID: 0244201879 Enrollment ID: I20230118001442 |
| Provider Name | Susan Helene Bertuglia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720715915 PECOS PAC ID: 6204200819 Enrollment ID: I20230322002131 |
| Provider Name | Holly Jean Wallraff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245586999 PECOS PAC ID: 3870740350 Enrollment ID: I20230919002806 |
| Provider Name | Tasleem Pierce |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649959826 PECOS PAC ID: 3779939400 Enrollment ID: I20231031003694 |
| Provider Name | Alexandra Tatooles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033996434 PECOS PAC ID: 5193174316 Enrollment ID: I20231213003811 |
| Provider Name | Angela M Boswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467640086 PECOS PAC ID: 5597118703 Enrollment ID: I20240124001518 |
| Provider Name | Katherine R Sangster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811625536 PECOS PAC ID: 4284071408 Enrollment ID: I20240325000551 |
| Provider Name | Erika Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982462198 PECOS PAC ID: 4789024175 Enrollment ID: I20240502001409 |
| Provider Name | Megan Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992477103 PECOS PAC ID: 2567802960 Enrollment ID: I20240502001555 |
| Provider Name | Jessica Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932974102 PECOS PAC ID: 5890137087 Enrollment ID: I20240520001292 |
| Provider Name | Kurt H Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104178649 PECOS PAC ID: 3779925003 Enrollment ID: I20240531001218 |
| Provider Name | Samantha Kristine Traum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316799505 PECOS PAC ID: 8224570791 Enrollment ID: I20240612000995 |
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