Jill Mallin, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2850-57 Issued in WI

Practice address

201 N Main St Ste 411
Fort Atkinson, WI 53538-1805

Phone

(920) 397-4015

Fax

(608) 237-2146

NPI assigned

Jun 1, 2020

Sex

Female

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

Enrolled in WI

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, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Hidden Path Counseling, LLC

  • Community/Behavioral Health Agency
  • Fort Atkinson, WI
  • NPI 1528683679
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1184248593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N MAIN ST STE 411",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381805",
            "telephone_number": "920-397-4015",
            "fax_number": "608-237-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N MAIN ST STE 411",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381805",
            "telephone_number": "920-397-4015",
            "fax_number": "608-237-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIN",
        "first_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2850-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Luisier, D.D.S.
• Qingze LV, DMD
• Leah Clare Lyle, LMFT
• Elizabeth H Lynk, MD
• Matthew Walter Maciejewski, DPM
• Matthew Mallin, LCSW
• Stephen Randall Marion, OD
• Betsy Martin Devine, PA C
• Emma Yvonne Martin, LPC-IT
• James Paul Martin, MD MPH

• Psychologist in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.