Mallory Primm

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.011172 Issued in IL

Practice address

25 E Washington St Ste 1717
Chicago, IL 60602-1839

Phone

(312) 566-8536

NPI assigned

Mar 1, 2024

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

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.

• Chicago Center for Growth and Change, LLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1255793360
  NPD

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1114784501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5246 W CARMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E WASHINGTON ST STE 1717",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021839",
            "telephone_number": "312-566-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMM",
        "first_name": "MALLORY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.011172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Primer
• Jason Primer, M.D.
• Aurea D Primero
• Primeroutetransportation, LLC
• Primerx, Inc.
• Primo Center for Women and Children
• Primo Center for Women and Children
• Sarah Primus, PTA
• Gregory Primuth, RPH
• Brandy Elaine Prince, M.H.S

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.