Active NPI
Jenna Gidman-Dutta
- Clinical Psychologist
- Downers Grove, IL
National Provider Identifier
1245048834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071011335
- Practice address
- 1315 Butterfield Rd Ste 208
Downers Grove, IL 60515-5602 - Phone
- (630) 441-4415
- NPI assigned
- Dec 27, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071011335 | IL | Primary |
Addresses
Primary practice location
1315 Butterfield Rd Ste 208
Downers Grove, IL 60515-5602
Mailing address
4315 Chelsea Manor Cir
Aurora, IL 60504-3275
Phone (574) 286-8375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071011335 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735257600000",
"number": "1245048834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4315 CHELSEA MANOR CIR",
"city": "AURORA",
"state": "IL",
"postal_code": "605043275",
"telephone_number": "574-286-8375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1315 BUTTERFIELD RD STE 208",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605155602",
"telephone_number": "630-441-4415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIDMAN-DUTTA",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-27",
"last_updated": "2024-12-27",
"certification_date": "2024-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071011335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downers Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.