James John Kotleba, LIC CLINICAL PSYCHOL

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071-002484 Issued in IL

Practice address

745 S 8TH St
West Dundee, IL 60118-3602

Phone

(800) 428-7260

Fax

(847) 428-7269

NPI assigned

Feb 18, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Davken Associates, P.C.

  • Clinical Psychologist
  • Deerfield, IL
  • NPI 1457393159
  NPD (past)

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1164729620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745- S 8TH ST",
            "city": "W. DUNDEE",
            "state": "IL",
            "postal_code": "60118",
            "telephone_number": "847-428-7260",
            "fax_number": "847-428-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 S 8TH ST",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "601183602",
            "telephone_number": "800-428-7260",
            "fax_number": "847-428-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTLEBA",
        "first_name": "JAMES",
        "middle_name": "JOHN",
        "credential": "LIC CLINICAL PSYCHOL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-18",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071002484",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-002484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie S King, D.C.
• Deborah L Kivett, LCSW
• Janice Pulchart Knapp, LCSW
• David C Kolbaba, D.C., CCN, DACBN
• Arash Koochek, M.D.
• Klaudia Kulpa-Lindgren, OT
• Philip G Lambruschi, M.D.
• Armani Lang
• Stephanie Ann Lavalla, PHAMD
• Karen Lee, O.D

• Psychologist in West Dundee, IL
• Providers in West Dundee, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.