Jillon S. Vander Wal

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP03007 Issued in KS

Practice address

4801 E Linwood Blvd
Kansas City, MO 64128-2226

Phone

(816) 861-4700

NPI assigned

May 16, 2007

Last updated

May 31, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1467669960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14934 S TURNBERRY ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660616033",
            "telephone_number": "314-255-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 E LINWOOD BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641282226",
            "telephone_number": "816-861-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10555 Marty St",
            "address_purpose": "LOCATION",
            "city": "Overland Park",
            "state": "KS",
            "postal_code": "662122555",
            "country_code": "US",
            "telephone_number": "913-956-6212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "JILLON",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2022-05-31",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MO",
            "license": "2004021723",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "KS",
            "license": "LP03007",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2004021723",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "KS",
            "license": "LP03007",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "MO",
            "license": "2004021723",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "LP03007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcy Leigh Vandament, PHD
• Culle L. Vande Garde, LCSW, CAC
• Michal Victoria Vande Kamp
• Nicholas Ryan Vande Kerkhoff, PA-C
• Caitlin Vandell, MS, CCC-SLP
• Hilah Sargent Vanderlippe
• Angela Clements Vanderpool, RN, MSN, CPNP
• Stacey Vanderpool, NP
• Michael Jon Vanderwaal, LCSW
• Susan K Vandeusen, PLPC

• Clinical Psychologist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.