Active NPI
Jacqueline Grace Rea, PHD, ABPP-CN
- Clinical Neuropsychologist
- Orland Park, IL
National Provider Identifier
1487829867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 071007463
- Practice address
- 10730 W 143Rd St Ste 37
Orland Park, IL 60462-1940 - Phone
- (800) 564-0863
- NPI assigned
- Apr 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 071007463 | IL | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 071007463 | IL |
Addresses
Primary practice location
10730 W 143Rd St Ste 37
Orland Park, IL 60462-1940
Mailing address
10730 W 143Rd St Ste 37
Orland Park, IL 60462-1940
Phone (800) 564-0863
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071007463 | IL | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416873600000",
"number": "1487829867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10730 W 143RD ST STE 37",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604621940",
"telephone_number": "800-564-0863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10730 W 143RD ST STE 37",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604621940",
"telephone_number": "800-564-0863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REA",
"first_name": "JACQUELINE",
"middle_name": "GRACE",
"name_prefix": "Dr.",
"credential": "PHD, ABPP-CN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-25",
"last_updated": "2014-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "IL",
"license": "071007463",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "IL",
"license": "071007463",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.