Active NPI
Vincent Miller
- School Psychologist
- Bolingbrook, IL
National Provider Identifier
1013423847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 2360793
- Practice address
- 200 Recreation Dr
Bolingbrook, IL 60440-3071 - Phone
- (630) 972-9200
- NPI assigned
- Dec 15, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 2360793 | IL | Primary |
Addresses
Primary practice location
200 Recreation Dr
Bolingbrook, IL 60440-3071
Mailing address
200 Recreation Dr
Bolingbrook, IL 60440-3071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2360793 | IL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513296000000",
"number": "1013423847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 RECREATION DR",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604403071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 RECREATION DR",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604403071",
"telephone_number": "630-972-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "VINCENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-15",
"last_updated": "2017-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IL",
"license": "2360793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
- Midwest Functional Psychiatry
- Midwest Hyperbaric Institute, P.C.
- Midwest Rehabilitation & Wellness Center
- Midwest Wound Care Incorporated
- Shunta M Milam, AAS, BA, M.ED, MBA
- Mindful Occupational Therapy LLC
- Allison Mitch, DPT
- Donita Mitchell-Gage, CERTIFIED HAIR LOSS
- Tricia L Mitchell, DPT, MPT
- Roopali Mittal, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.