Susan Elizabeth Kortlander, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5774 Issued in FL

Practice address

2771 Executive Park Dr
Suite 4
Weston, FL 33331-3642

Phone

(954) 385-4696

Fax

(954) 385-8385

NPI assigned

Aug 3, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Weston Psychcare PA

  • Psychologist
  • Weston, FL
  • NPI 1770680704
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295743680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2771 EXECUTIVE PARK DR",
            "address_2": "SUITE 4",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313642",
            "telephone_number": "954-385-4696",
            "fax_number": "954-385-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2771 EXECUTIVE PARK DR",
            "address_2": "SUITE 4",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313642",
            "telephone_number": "954-385-4696",
            "fax_number": "954-385-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTLANDER",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jaclyn Marie Kowalonek, AUD
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• Psychologist in Weston, FL
• Providers in Weston, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.