NPIMap

Organization Active NPI

The Prairie Clinic

  • Clinical Child & Adolescent Psychologist
  • Geneva, IL
National Provider Identifier
1184863847
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
071006627 Issued in IL
Legal business name
THE PRAIRIE CLINIC
Practice address
1541 E Fabyan Pkwy
Suite 101
Geneva, IL 60134-4105
Phone
(630) 845-9644
Fax
(630) 845-9678
NPI assigned
Feb 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

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

Authorized official

Name
Mrs. Stacey M Wahlberg
Title
Office Manager
Phone
(630) 845-9644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X 071006627 IL Primary

Addresses

Primary practice location

1541 E Fabyan Pkwy
Suite 101
Geneva, IL 60134-4105

Mailing address

1541 E Fabyan Pkwy
Suite 101
Geneva, IL 60134-4105
Phone (630) 845-9644

National Provider Directory

National Provider Directory

Locations

1541 E Fabyan Pkwy
#101
Geneva, IL 60134
Phone (630) 845-9644

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1184863847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 E FABYAN PKWY",
            "address_2": "SUITE 101",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344105",
            "telephone_number": "630-845-9644",
            "fax_number": "630-845-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 E FABYAN PKWY",
            "address_2": "SUITE 101",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344105",
            "telephone_number": "630-845-9644",
            "fax_number": "630-845-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRAIRIE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "WAHLBERG",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-845-9644",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071006627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.