Andrew Dejong, SSP

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

2353028 Issued in IL

Practice address

1801 E Lincoln Hwy
New Lenox, IL 60451-3801

Phone

(815) 717-3601

NPI assigned

Aug 26, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Lincoln-Way High School District 210

  • Local Education Agency (LEA)
  • New Lenox, IL
  • NPI 1124323522
  NPD (past)

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1104593219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E LINCOLN HWY",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604513801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E LINCOLN HWY",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604513801",
            "telephone_number": "815-717-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "ANDREW",
        "credential": "SSP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IL",
            "license": "2353028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adejong@lw210.org",
            "affiliation": "N",
            "endpointDescription": "Practice Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "1801 E Lincoln Hwy",
            "city": "New Lenox",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604513801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• School Psychologist in New Lenox, IL
• Providers in New Lenox, IL by specialty
• School Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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.