Taylor Mae Bonno, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010984 Issued in IL

Practice address

11800 S 75TH Ave FL 3
Palos Heights, IL 60463-1033

Phone

(708) 671-8440

Fax

(708) 671-8446

NPI assigned

Jun 19, 2023

Last updated

Jun 19, 2023By the provider in NPPES

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

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

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  Medicare reassignment Care Compare group NPD
• Miracare Neuro Behavioral Health, PC

  dba Palos Behavioral Health Professionals

  • Psychologist
  • Palos Heights, IL
  • NPI 1649329251
  NPD (past)
• Psychology Specialists LTD

  dba LifeStance Health

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1164107124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 POMEROON ST APT 306",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605404890",
            "telephone_number": "678-386-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 S 75TH AVE FL 3",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631033",
            "telephone_number": "708-671-8440",
            "fax_number": "708-671-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNO",
        "first_name": "TAYLOR",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick S Blair, PT
• Samara Blair, CRNA
• Darius Bliznikas, MD
• Nadine E Bolger, MD
• Mark C. Bonen, MHS MAC CRADC
• Ashley Boomsma
• Jessica Born, LCSW
• George W Borrelli, D.O.
• Shakiara Bowie
• Madison Ashlee Bowling

• Clinical Psychologist in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.