Jennifer L Sudbrack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1349 Issued in KY

Practice address

722 Scott St
Covington, KY 41011-2418

Phone

(859) 431-2225

Fax

(859) 578-2388

NPI assigned

May 18, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Northern Kentucky Mental Health Mental Retardation Regional Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Covington, KY
  • NPI 1578527610
  NPD (past)
• Northern Kentucky Mental Health Mental Retardation Regional Board

  • Psychiatric Hospital
  • Covington, KY
  • NPI 1679775514
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1114970191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 FARRELL DR",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410113717",
            "telephone_number": "859-331-3292",
            "fax_number": "859-578-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 SCOTT ST",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410112418",
            "telephone_number": "859-431-2225",
            "fax_number": "859-578-2388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDBRACK",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "1349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0256",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shana Marie Stewart, NP
• Stephanie Stoian, BS
• Rachel Stone, BA
• Stephanie L Strausbaugh, MSW
• Shannon Strotman
• Summit Medical Group, Inc
• Summit Medical Group, Inc
• Summit Medical Group, Inc
• Randi Beth Sutnick, MSED
• Anthony T Swanholm, OD

• All providers in Covington, KY
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.