Robert Joseph Boucek Jr., PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008794 Issued in IL

Practice address

2506 Galen Dr
#103
Champaign, IL 61821-7046

Phone

(217) 398-0744

Fax

(217) 398-0778

NPI assigned

Jun 22, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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

State licenses

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430438400000",
    "number": "1508177734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 GALEN DRIVE",
            "address_2": "#103",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217047",
            "telephone_number": "217-398-0744",
            "fax_number": "217-398-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 GALEN DR",
            "address_2": "#103",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217046",
            "telephone_number": "217-398-0744",
            "fax_number": "217-398-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCEK",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2015-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008794",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23495",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Borrmann
• Cathy L Borst, OTR/L, CHT
• Rebekah C Bosley, M.S. CCC-SLP
• Caitlin Botcher
• Lauren D Boucek, LCSW
• Joe Boudreau, RPH
• Seth William Boughton, MSW
• Sarah Jo Bouton, DPT
• Kevin R Bowie
• Jeffrey Boyd

• Clinical Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.