Jeffery Siddall

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

1010 Jorie Blvd
Oak Brook, IL 60523-2215

Phone

(630) 710-5729

NPI assigned

May 9, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Oak Brook Counseling & Wellness LTD

  • Community/Behavioral Health Agency
  • Oak Brook, IL
  • NPI 1568721447

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1093371536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 WESLEY AVE APT 2N",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603023977",
            "telephone_number": "708-655-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 JORIE BLVD",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232215",
            "telephone_number": "630-710-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDALL",
        "first_name": "JEFFERY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-09",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilhelmina M Shoger, PHD
• Collin Steele Shotts, PSY.D.
• Shukla Clinical, LLC
• Arvind Shukla, M.B.B.S.
• Ravi Shukla, O.D.
• Pamela A Signorella, L AC
• Omayra Silva, APN
• Shawn Singh, DC
• George Edward Sippel
• Michelle Toledo Sison

• Developmental Therapist in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.