Active NPI
Jennifer Mary Wilson, PSYD
- Clinical Psychologist
- Rockford, IL
National Provider Identifier
1114076460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 71007181
- Practice address
- 5702 Elaine Dr
Suite a
Rockford, IL 61108-2458 - Phone
- (815) 601-3981
- Fax
- (815) 399-1959
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 71007181 | IL | Primary |
Addresses
Primary practice location
5702 Elaine Dr
Suite a
Rockford, IL 61108-2458
Mailing address
240 Walworth St
Sharon, WI 53585-9606
Phone (262) 337-1702
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Psychological Services Inc | Clinical | Past | Accepting new patients |
| Creative Psychology, LTD. | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Rockford, IL
- NPI 1144343625
-
- Clinical Psychologist
- Crystal Lake, IL
- NPI 1295758092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444262400000",
"number": "1114076460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 WALWORTH ST",
"city": "SHARON",
"state": "WI",
"postal_code": "535859606",
"telephone_number": "262-337-1702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5702 ELAINE DR",
"address_2": "SUITE A",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082458",
"telephone_number": "815-601-3981",
"fax_number": "815-399-1959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "MARY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2015-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "71007181",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.