Jennie Probst
Individual provider Active NPI School Psychologist · Manhattan, IL
NPI 1053970848 · NPPES record last updated Jun 6, 2019
Key facts
- NPI
- 1053970848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- Practice address
- 25440 S Gougar Rd
Manhattan, IL 60442-9511 - Phone
- (815) 478-6093
- NPI assigned
- Jun 6, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manhattan School District 114 | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Yes |
Addresses
Primary practice location
25440 S Gougar Rd
Manhattan, IL 60442-9511
Mailing address
25440 S Gougar Rd
Manhattan, IL 60442-9511
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.