NPIMap

Organization Active NPI

Embolden Clinical Services

  • Psychologist
  • Wheaton, IL
National Provider Identifier
1467643791
Registry record updated Aug 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
EMBOLDEN CLINICAL SERVICES
Practice address
1755 S Naperville Rd
Suite 100
Wheaton, IL 60187-8144
Phone
(630) 510-3248
NPI assigned
Aug 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2007

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

Authorized official

Name
Dennis Randall Bowling, H.D.NPI 1457421810
Title
President
Phone
(630) 510-3248

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X IL Primary

Addresses

Primary practice location

1755 S Naperville Rd
Suite 100
Wheaton, IL 60187-8144

Mailing address

1755 S Naperville Rd
Suite 100
Wheaton, IL 60187-8144
Phone (630) 510-3248

Other identifiers 5

IdentifierTypeStateIssuer
1043857OtherCIGNA
206272OtherMANAGED HEALTH NETWORK
02220198OtherBLUE CROSS BLUE SHIELD
144300OtherCOMPSYCHE
5777746OtherAETNA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1467643791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 S NAPERVILLE RD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601878144",
            "telephone_number": "630-510-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 S NAPERVILLE RD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601878144",
            "telephone_number": "630-510-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBOLDEN CLINICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-510-3248",
        "authorized_official_credential": "H.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1043857",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH NETWORK",
            "identifier": "206272",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02220198",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCHE",
            "identifier": "144300",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5777746",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.

Verify at the official NPI Registry.