Joann K. Nishimoto, PSYD, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071006907 Issued in IL

Legal business name

JOANN K. NISHIMOTO, PSYD, LLC

Practice address

510 N Lake St Ste 3
Mundelein, IL 60060-1800

Phone

(847) 337-7892

NPI assigned

Oct 9, 2009

Last updated

Oct 9, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joann K Nishimoto, PSYDNPI 1598913220

Title

Owner/Psychologist

Phone

(847) 337-7892

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joann Kendrick Nishimoto, PSY.D.

  • Clinical Psychologist
  • Mundelein, IL
  • NPI 1598913220
  Authorized official Same address or phone

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1508191446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 N LAKE ST STE 3",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601800",
            "telephone_number": "847-337-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N LAKE ST STE 3",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601800",
            "telephone_number": "847-337-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOANN K. NISHIMOTO, PSYD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "NISHIMOTO",
        "authorized_official_first_name": "JOANN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "847-337-7892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; 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.