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NORTHWESTERN MEDICINE
NPI 1306417076
Clinic/Center - Mental Health (Including Community Mental Health Center) in Dekalb, IL

Active since July 05, 2021CLIA 14D1032590 · Waiver
12 HEALTH SERVICES DR, DEKALB, IL 60115(815) 756-4875 Get Directions Write a Review

NPPES record last updated: July 5, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Northwestern Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHWESTERN MEDICINE (NPI 1306417076) is a healthcare organization registered as a mental health (including community mental health center) in Dekalb, Illinois and active in the NPI registry since July 2021. The organization holds a CLIA Waiver certificate valid through October 25, 2026 and lists Bettyjo Fortune, Financial Assessor, as its authorized official.

NPPES Registry Identity

NPI1306417076
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameNORTHWESTERN MEDICINE
Location Address12 HEALTH SERVICES DRDekalb, IL 60115-9637
Mailing AddressPo Box 1109Dekalb, IL 60115-7109
Phone(815) 756-4875
Organization SubpartNo
Authorized OfficialBettyjo FortuneFinancial Assessor · (815) 756-4875
Enumeration DateJuly 5, 2021
NPPES CertifiedJuly 5, 2021
✔ NPI 1306417076 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
12 HEALTH SERVICES DR, Dekalb, IL 60115
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Other Identifiers 1

Medicaid1316304058IL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1032590

Northwestern Medicine Regional Medical Group · Dekalb, IL
Active · expires Oct 25, 2026
CLIA Number14D1032590
Laboratory TypePhysician Office
Certificate Effective DateOctober 26, 2024
Certificate Expiration DateOctober 25, 2026
Laboratory DirectorShaun Mathen
Laboratory Phone(815) 754-0300
Laboratory LocationNorthwestern Medicine Regional Medical Group626 Bethany Rd, Dekalb, IL 60115
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER L WEBER LSW, CADC
Social Worker (Clinical)
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
CHRISTI JOHNSON B.S., M.H.P.
Counselor (Mental Health)
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
CHRISTINE ALEXANDRA ESPE MAXWELL MSED, LCPC, NCC
Counselor
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
TATJANA N WILLIAMS LSW
Social Worker
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
JASMINE YOUNG
Counselor (Mental Health)
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
CASSIE DODD
Counselor (Mental Health)
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
REBECCA LEACH
Social Worker
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875
VALERIE PENA-HERNANDEZ
Social Worker
12 HEALTH SERVICES DR
DEKALB, IL 60115
Dekalb County (815) 756-4875

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northwestern Medicine's NPI number?

The NPI number for Northwestern Medicine is 1306417076. It was assigned to this organization in the NPPES registry on July 5, 2021.

Where is Northwestern Medicine located?

Northwestern Medicine is located at 12 Health Services Dr, Dekalb, IL 60115. The listed phone number is (815) 756-4875.

What is Northwestern Medicine's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Does Northwestern Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1032590) is associated with this NPI, valid through October 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Northwestern Medicine was last updated on July 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.