NPIMap

Organization Active NPI

Jennifer Gibson, PSYD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1003211426
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071007651 Issued in IL
Legal business name
JENNIFER GIBSON, PSYD
Practice address
2650 W Montrose Ave
Suite 200
Chicago, IL 60618-1560
Phone
(872) 205-6110
NPI assigned
Oct 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer Gibson, PSYDNPI 1164544839
Title
Licensed Clinical Psychologist
Phone
(312) 316-5551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071007651 IL Primary

Addresses

Primary practice location

2650 W Montrose Ave
Suite 200
Chicago, IL 60618-1560

Mailing address

4334 N Bell Ave
Chicago, IL 60618-1610
Phone (312) 316-5551

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1003211426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4334 N BELL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181610",
            "telephone_number": "312-316-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 W MONTROSE AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181560",
            "telephone_number": "872-205-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER GIBSON, PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "312-316-5551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; 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.