Jacob Rosser, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009553 Issued in IL

Practice address

3257 N Sheffield Ave Ste 118
Chicago, IL 60657-2276

Phone

(309) 868-3654

NPI assigned

Nov 29, 2010

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

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.

• Renew You Counseling Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1750807749
  NPD Authorized official

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1164724019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W DIVERSEY PWKY UNIT G-2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141201",
            "telephone_number": "773-236-8566",
            "fax_number": "773-257-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3257 N SHEFFIELD AVE STE 118",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572276",
            "telephone_number": "309-868-3654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1209 W Diversey Pkwy Unit G-2",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60614",
            "country_code": "US",
            "telephone_number": "773-236-8566",
            "fax_number": "773-257-7553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSSER",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-29",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Ross
• Joseph W. Rossa, D.D.S.
• Jennifer L Rossato, D.O.
• Gail L Rosseau, MD
• Jennifer Landau Rossen, M.D.
• Renee Ann Rossetti, OTR L
• Antonio Rossi, DMD
• Benedetta Rossi, LCPC
• Claire Pezzini Rossi, PT, DPT
• Enrica Rossi, MD

• 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 May 6, 2022; 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.