Jodi Fourt, PSYD
Individual provider Active NPI Clinical Psychologist · Roscoe, IL
NPI 1053662445 · NPPES record last updated May 4, 2020
Key facts
- NPI
- 1053662445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 071.010162 (IL)
- Practice address
- 5334 Williams Dr
Roscoe, IL 61073-7320 - Phone
- (224) 703-5595
- NPI assigned
- Sep 25, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1530 N Randall Rd
Suite 220
Elgin, IL 60123-7879
Phone (224) 703-5595
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200909002063 | IL | Practitioner - Clinical Psychologist | 5294153110 |
Reassigns benefits to 2 organizations Practice locations: Elgin, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.010162 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jodi M Fourt | Clinical | Current |
Accepting new patients |
| Vitae Health Medical Illinois, PLLC | Current |
Accepting new patients |
Locations
303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347
1530 N Randall Rd
Ste 220
Elgin, IL 60123
Phone (224) 703-5595
2773 Skokie Valley Rd
Highland Park, IL 60035
Phone (847) 266-9266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.010162 | IL | Yes |
Addresses
Primary practice location
5334 Williams Dr
Roscoe, IL 61073-7320
Mailing address
13 Crossview CT
Lake in the Hills, IL 60156-5841
Phone (224) 703-5595
Other providers in Roscoe, IL
- Janice Marian Ethington
- Afoma Phoebe Ezidinma
- Dakota L Felckowski
- William Brian Flaskamp
- Vicki Foti
- Francis Family Chiropractic LTD
- Margaret Allensworth Franklin
- Tiffany Renee Franklin
- Jamie TF Frantz
- Sara Gaddini
All providers in Roscoe, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.