Individual provider Active NPI

Angela Lynn Neese, PHD

  • Clinical Psychologist
  • Peoria, IL
National Provider Identifier
1215544754
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.010328 Issued in IL
Practice address
7317 N Willow Lake CT
Peoria, IL 61614-8227
Phone
(309) 691-4408
NPI assigned
Sep 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.010328 IL Primary

Addresses

Primary practice location

7317 N Willow Lake CT
Peoria, IL 61614-8227

Mailing address

524 W Horseshoe TRL
Edelstein, IL 61526-9722
Phone (309) 243-7204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20201104002250 IL Practitioner - Clinical Psychologist 1557771466

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7317 N Willow Lake CT
Peoria, IL 61614-8227

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071.010328ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 19, 2020 Accepting new patients

Locations

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

7317 N Willow Lake Ct
Peoria, IL 61614
Phone (309) 683-7373

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1215544754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 W HORSESHOE TRL",
            "city": "EDELSTEIN",
            "state": "IL",
            "postal_code": "615269722",
            "telephone_number": "309-243-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7317 N WILLOW LAKE CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148227",
            "telephone_number": "309-691-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEESE",
        "first_name": "ANGELA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.