Individual provider Active NPI

Jennifer Danielle Vollman, PSYD

  • Psychologist
  • Chicago, IL
National Provider Identifier
1083137905
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071.011167 Issued in IL
Practice address
5729 S Parkside Ave
Chicago, IL 60638-3714
Phone
(708) 837-8896
NPI assigned
Jul 23, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 071.011167 IL Primary

Addresses

Primary practice location

5729 S Parkside Ave
Chicago, IL 60638-3714

Mailing address

5729 S Parkside Ave
Chicago, IL 60638-3714
Phone (708) 837-8896

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

LicenseStateTypeSpecialty
071.011167ILMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Living My Best Life, LLC Psychologist CurrentSince Jul 1, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1083137905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5729 S PARKSIDE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606383714",
            "telephone_number": "708-837-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5729 S PARKSIDE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606383714",
            "telephone_number": "708-837-8896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOLLMAN",
        "first_name": "JENNIFER",
        "middle_name": "DANIELLE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-23",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.011167",
            "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 Aug 19, 2024; 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.