Stephanie Kelly, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009850 Issued in IL

Practice address

7620 W 159TH St Ste 101
Orland Park, IL 60462-5400

Phone

(708) 714-7377

NPI assigned

Mar 18, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stephanie Mark Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Thriving You, PLLC

  • Clinical Psychologist
  • Orland Park, IL
  • NPI 1659085470

  Clinical, IL

  Medicare reassignment NPD Authorized official
• Jewish Child and Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1821387119
  NPD (past)

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1447574595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7620 W 159TH ST STE 101",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604625400",
            "telephone_number": "708-714-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7620 W 159TH ST STE 101",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604625400",
            "telephone_number": "708-714-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "STEPHANIE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-18",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "MARK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jamie Keating, PHARM.D
• Michael Kehoe
• Keifer Neuropsychology, LLC
• Jasmine Keith
• Bailey James Kellett
• Stephanie Woeste Kelly, PA-C
• Paul Kelsey Jr., BA
• Jennifer Brianne Kempczynski
• Kendrick Brain Restoration
• Kendrick Brain Restoration

• All providers in Orland Park, IL
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.