NPIMap

Organization Active NPI

Illinois Geriatric Psychological Services P.C.

  • Clinical Psychologist
  • Harvard, IL
National Provider Identifier
1184999310
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071007428 Issued in IL
Legal business name
ILLINOIS GERIATRIC PSYCHOLOGICAL SERVICES P.C.
Practice address
503 4TH St
Harvard, IL 60033-2311
Phone
(815) 212-3209
NPI assigned
Mar 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Authorized official

Name
Peter M Koehn, PH.D.
Title
President
Phone
(815) 212-3209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 071007428 IL Primary

Addresses

Primary practice location

503 4TH St
Harvard, IL 60033-2311

Mailing address

503 4TH St
Harvard, IL 60033-2311

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1184999310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 4TH ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600332311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 4TH ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600332311",
            "telephone_number": "815-212-3209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS GERIATRIC PSYCHOLOGICAL SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "KOEHN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-212-3209",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.