Diane F Mittelhauser, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071004901 Issued in IL

Practice address

335 N River St Ste 210
Batavia, IL 60510-2386

Phone

(630) 879-8164

Fax

(630) 879-6806

NPI assigned

Dec 11, 2006

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

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

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.

• Prairie Psychotherapy Services LLC

  • Clinical Psychologist
  • Batavia, IL
  • NPI 1497067292
  Medicare reassignment NPD

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1497815617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 N RIVER ST STE 210",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605102386",
            "telephone_number": "630-879-8164",
            "fax_number": "630-879-6806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 N RIVER ST STE 210",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605102386",
            "telephone_number": "630-879-8164",
            "fax_number": "630-879-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTELHAUSER",
        "first_name": "DIANE",
        "middle_name": "F",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071004901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alfred Meo, LMT, PERSONAL TRAINE
• Elizabeth Irene Mereness
• Mettashuttle Corporation
• Shannon Meyer
• Kelly Mikoda, M. A. CCC-SLP
• Modulation Therapy Services LLC
• Rebecca R Mohan
• Brittany Mollenhauer
• Ayarri Moore
• Colin Lance Moore, BCBA

• Clinical Psychologist in Batavia, IL
• Providers in Batavia, 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 19, 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.