Individual provider Active NPI

Jennifer Suor, PH.D.

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1104508498
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0721.010822 Issued in IL
Practice address
1747 W Roosevelt Rd
Chicago, IL 60608-1264
Phone
(312) 355-3871
NPI assigned
Aug 4, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0721.010822 IL Primary

Addresses

Primary practice location

1747 W Roosevelt Rd
Chicago, IL 60608-1264

Mailing address

1747 W Roosevelt Rd
Chicago, IL 60608-1264

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231107002209 IL Practitioner - Clinical Psychologist 7113374547 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0721.010822ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Clinical CurrentSince Sep 27, 2023 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Sep 27, 2023 Accepting new patients

Locations

1747 W Roosevelt Rd
Chicago, IL 60608
Phone (312) 996-2200

7825 Solution Ctr
Chicago, IL 60677

912 S Wood St
Chicago, IL 60612
Phone (312) 996-2200

Organizations & group practices 2

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": "1691107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1104508498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-355-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUOR",
        "first_name": "JENNIFER",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-04",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "0721.010822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.