Active NPI
Kelly Jane Balk, PSY.D., L.P.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1043605827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.009051
- Practice address
- 333 N Michigan Ave
Suite 1900
Chicago, IL 60601-3901 - Phone
- (773) 321-2761
- NPI assigned
- Mar 30, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.009051 | IL | Primary |
Addresses
Primary practice location
333 N Michigan Ave
Suite 1900
Chicago, IL 60601-3901
Mailing address
916 W Diversey Pkwy
Unit 305
Chicago, IL 60614-1884
Phone (608) 412-0626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 21, 2023 through Feb 21, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009051 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427673600000",
"number": "1043605827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "916 W DIVERSEY PKWY",
"address_2": "UNIT 305",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606141884",
"telephone_number": "608-412-0626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 N MICHIGAN AVE",
"address_2": "SUITE 1900",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606013901",
"telephone_number": "773-321-2761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALK",
"first_name": "KELLY",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PSY.D., L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-30",
"last_updated": "2015-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.009051",
"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 Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.