Sandra Ellen Johnson Clavelli, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

71007250 Issued in IL

Practice address

420 W. Grand Ave
Lake Villa, IL 60046

Phone

(847) 245-6469

NPI assigned

May 16, 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

• Dr. Sandra Ellen Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
• IL HMO C-SNP
• IL PPO Downstate
• devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
• devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003023714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 HOBSON RD APT 6",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171550",
            "telephone_number": "847-636-7637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W. GRAND AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "60046",
            "telephone_number": "847-245-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAVELLI",
        "first_name": "SANDRA",
        "middle_name": "ELLEN JOHNSON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71007250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "JOHNSON",
            "middle_name": "ELLEN",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patricia Cerenil
• Children'S Speech Services, PLLC
• Citadel of Hope Home Health Care Inc.
• Holli Clauser, RBT-17-34670
• Mark J Clauser, RBT
• Ricky Joseph Colmer, PHD, LAC.
• Diana Cuna
• De Los Reyes Dental LTD.
• Jose B De Los Reyes, DMD
• Kristine Sue Decant, DPT, NCS

• Clinical Psychologist in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.