NPIMap

Organization Active NPI

Jeff D. Kazmierczak, Psy.D., P.C.

  • Clinical Neuropsychologist
  • Bourbonnais, IL
National Provider Identifier
1316203896
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
JEFF D. KAZMIERCZAK, PSY.D., P.C.
Practice address
19 Heritage Dr
Suite 211
Bourbonnais, IL 60914-1369
Phone
(815) 933-8760
Fax
(815) 933-9061
NPI assigned
Apr 9, 2012
Last updated
Nov 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Authorized official

Name
Dr. Jeffrey David Kazmierczak, PSY.D.NPI 1902178015
Title
Psychologist
Phone
(773) 412-2778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X Primary
Adult Development & Aging Psychologist 103TA0700X
Clinical Psychologist 103TC0700X
Counseling Psychologist 103TC1900X
Clinical Child & Adolescent Psychologist 103TC2200X
Rehabilitation Psychologist 103TR0400X 071008293 IL

Addresses

Primary practice location

19 Heritage Dr
Suite 211
Bourbonnais, IL 60914-1369

Mailing address

2626 Flossmoor Rd
2E
Flossmoor, IL 60422-1555
Phone (773) 412-2778

National Provider Directory

National Provider Directory

Locations

19 Heritage Dr
#211
Bourbonnais, IL 60914
Phone (815) 933-8760

19 Heritage Dr
Ste 211
Bourbonnais, IL 60914
Phone (815) 933-8760

2626 Flossmoor Rd
Unit 2EAST
Flossmoor, IL 60422
Phone (773) 412-2778

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1316203896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 FLOSSMOOR RD",
            "address_2": "2E",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221555",
            "telephone_number": "773-412-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HERITAGE DR",
            "address_2": "SUITE 211",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141369",
            "telephone_number": "815-933-8760",
            "fax_number": "815-933-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFF D. KAZMIERCZAK, PSY.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-09",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "KAZMIERCZAK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-412-2778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "IL",
            "license": "071008293",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.