Active NPI
Jessica A McKinley-Simpson
- Clinical Child & Adolescent Psychologist
- Bloomington, IL
National Provider Identifier
1275214108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 20043982A
- Practice address
- 2103 E Washington St Ste 3B
Bloomington, IL 61701-4365 - Phone
- (309) 304-3047
- NPI assigned
- Jul 25, 2023
- 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 Child & Adolescent Psychologist | 103TC2200X | 20043982A | IN | Primary |
Addresses
Primary practice location
2103 E Washington St Ste 3B
Bloomington, IL 61701-4365
Mailing address
2103 E Washington St Ste 3B
Bloomington, IL 61701-4365
Phone (309) 304-3047
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 |
|---|---|---|---|
| 20043982A | IN | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755129600000",
"number": "1275214108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2103 E WASHINGTON ST STE 3B",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014365",
"telephone_number": "309-304-3047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2103 E WASHINGTON ST STE 3B",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014365",
"telephone_number": "309-304-3047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY-SIMPSON",
"first_name": "JESSICA",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-25",
"last_updated": "2025-08-14",
"certification_date": "2025-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "IN",
"license": "20043982A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.