Jennifer Lynn Pellicano, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008942 Issued in IL

Practice address

207 E Church St
Suite a
Sandwich, IL 60548-9803

Phone

(815) 786-8606

Fax

(815) 786-1541

NPI assigned

Jan 8, 2015

Sex

Female

Sole proprietor

No

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 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

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Compass Behavioral Health and Wellness, LLC

  • Professional Counselor
  • Naperville, IL
  • NPI 1225525918
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1225426570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST",
            "address_2": "SUITE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E CHURCH ST",
            "address_2": "SUITE A",
            "city": "SANDWICH",
            "state": "IL",
            "postal_code": "605489803",
            "telephone_number": "815-786-8606",
            "fax_number": "815-786-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLICANO",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-08",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Open Door Rehabilitation Center
• Jill M Palko, M.D.
• Pavilion on Main Street LLC (Pavilion on Main Street)
• Peace & Consolation Counseling LLC
• Pediatric Home Therapy
• Petersen Health Business, LLC (Sandwich Rehabilitation & Health Care Center)
• Audrey Peterson, ALMFT
• Allison Peuler
• Pharmacy Operations, Inc (Medicine Shoppe)
• Prairie Healthcare, LTD (Sandwich Family Practice)

• Clinical Psychologist in Sandwich, IL
• Providers in Sandwich, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; 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.