Active NPI
Susan Powell, PH.D.
- Clinical Psychologist
- Swansea, IL
National Provider Identifier
1396966958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 4972 Benchmark Centre
Suite 200
Swansea, IL 62226 - Phone
- (618) 920-2663
- NPI assigned
- May 1, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | IL | Primary |
Addresses
Primary practice location
4972 Benchmark Centre
Suite 200
Swansea, IL 62226
Mailing address
P.O. Box 2811
Blaine, WA 98231
Phone (618) 920-2663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08232031 | Other | IL | BLUE CROSS & BLUE SHIELD |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-004727 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396966958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 2811",
"city": "BLAINE",
"state": "WA",
"postal_code": "98231",
"telephone_number": "618-920-2663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4972 BENCHMARK CENTRE",
"address_2": "SUITE 200",
"city": "SWANSEA",
"state": "IL",
"postal_code": "62226",
"telephone_number": "618-920-2663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "08232031",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
Sources for this page
- 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.