Amy Jo Eiermann, PH.D., NCSP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010957 Issued in IL

Practice address

1913 W 19TH St Unit 3
Chicago, IL 60608-2647

Phone

(231) 534-4341

NPI assigned

Jun 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Amy Jo Bruno Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Third Coast Psychological Services, PLLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1417739186
  NPD Authorized official

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1417572181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 W 19TH ST UNIT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082647",
            "telephone_number": "231-534-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1913 W 19TH ST UNIT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082647",
            "telephone_number": "231-534-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIERMANN",
        "first_name": "AMY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "PH.D., NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6352000102",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "BRUNO",
            "middle_name": "JO",
            "prefix": "DR.",
            "credential": "PH.D., NCSP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kevin Toni Eid, MD
• Murad Eideh, PHARMD
• Grace Eiden
• Theresa R Eiden, PT
• Steven C Eidt, M.D.
• Gretchen Elizabeth Eifert, LPC
• Matthew Eifert
• Karin Eig, M.S., CF-SLP
• Maureen Elizabeth Eigenfeld
• Rodney I. Eiger

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.