KJP Alliance LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

KJP ALLIANCE LLC

Doing business as

Ellis Therapy

Practice address

16595 W Easton Ave Ste 1
Lincolnshire, IL 60069-2744

Phone

(847) 242-1669

Fax

(847) 242-1669

NPI assigned

Oct 22, 2020

Last updated

Oct 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Schaefer, LCPC

Title

Director

Phone

(773) 350-6560

Specialties & licenses 1

Addresses

Other names 1

• Ellis Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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.

• Lynn Rodgers, LCPC

  • Marriage & Family Therapist
  • Niles, IL
  • NPI 1780632448
  Medicare reassignment NPD
• Oana Demian, PSYD

  • Clinical Psychologist
  • Lincolnshire, IL
  • NPI 1730933896
  NPD (past)
• Anne P Montague, PHD

  • Clinical Psychologist
  • Skokie, IL
  • NPI 1730147042
  NPD (past)

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1417556283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 PARK DR",
            "city": "PORT BARRINGTON",
            "state": "IL",
            "postal_code": "600101031",
            "telephone_number": "773-350-6560",
            "fax_number": "847-242-1669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16595 W EASTON AVE STE 1",
            "city": "LINCOLNSHIRE",
            "state": "IL",
            "postal_code": "600692744",
            "telephone_number": "847-242-1669",
            "fax_number": "847-242-1669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KJP ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-350-6560",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellis Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adam Kehoe, M.A. ED., ATC
• Kirsten Kendler
• Katie Khoshaba
• Mary Kiolbasa, OTR/L
• Elizabeth A Kislov, FNP
• Timothy Paul Kosiba, PT
• Kovacevic Medicine PLLC
• KPM Therapy PLLC
• Richard Krajewski, PT
• Divya Kundal

• Clinical Psychologist in Lincolnshire, IL
• Providers in Lincolnshire, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.