Jeffrey Saunders Kellogg, PSY.D

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

071003739 Issued in IL

Practice address

3412 S Illinois Ave
Carbondale, IL 62903-8362

Phone

(618) 457-4488

Fax

(618) 457-8844

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Nicole Douglas Psychology and Wellness, PLLC

  • Clinical Psychologist
  • Carbondale, IL
  • NPI 1245181379
  NPD (past)
• Shawler Psychology, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Carbondale, IL
  • NPI 1710648605
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1093740862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 S ILLINOIS AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629038362",
            "telephone_number": "618-457-4488",
            "fax_number": "618-457-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 S ILLINOIS AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629038362",
            "telephone_number": "618-457-4488",
            "fax_number": "618-457-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOGG",
        "first_name": "JEFFREY",
        "middle_name": "SAUNDERS",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003739",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071003739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Kasten, M.ED., LCPC, RPT, NC
• Binit Katuwal, MD
• John Keehn, LCSW
• Katherine Kristen Adele Keller
• Jessica C Kelley, DPT
• Dina Kelly
• Constance Susan Kemp, M.D.
• Jodie Kennedy, L.C.S.W.
• Gardner Thomas Kenny, M.D.
• Christopher Ryan Kent

• Clinical Child & Adolescent Psychologist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Clinical Child & Adolescent Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.