NPIMap

Organization Active NPI

Jennifer C. Panning PSYD PC

  • Clinical Psychologist
  • Evanston, IL
National Provider Identifier
1326440454
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
JENNIFER C. PANNING PSYD PC
Practice address
636 Church St.
Ste. 510
Evanston, IL 60201-4508
Phone
(847) 864-0600
Fax
(847) 859-6996
NPI assigned
Sep 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Authorized official

Name
Jennifer C. Panning, PSYDNPI 1184704066
Title
President
Phone
(847) 864-0600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 71-006778 IL
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

636 Church St.
Ste. 510
Evanston, IL 60201-4508

Mailing address

636 Church St Ste 520
Evanston, IL 60201-4581
Phone (847) 864-0600

Other names 2

  • Mindful Psychology Associates Doing business as
  • Mindful Psychology Associates PC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1326440454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 520",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014581",
            "telephone_number": "847-864-0600",
            "fax_number": "847-859-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST.",
            "address_2": "STE. 510",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "847-864-0600",
            "fax_number": "847-859-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER C. PANNING PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "PANNING",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-864-0600",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": "71-006778",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mindful Psychology Associates PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mindful Psychology Associates PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.