Active NPI
Lisa Dejong
- School Psychologist
- Caledonia, IL
National Provider Identifier
1508372871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1840449
- Practice address
- 2311 Randolph St
Caledonia, IL 61011-9321 - Phone
- (815) 547-1977
- NPI assigned
- Dec 21, 2017
- Last updated
- Mar 17, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1840449 | IL | Primary |
Addresses
Primary practice location
2311 Randolph St
Caledonia, IL 61011-9321
Mailing address
2311 Randolph St
Caledonia, IL 61011-9321
Other practice location 1
633 W Perry St
Belvidere, IL 61008-3153
Phone (815) 544-9274
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1840449 | IL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1508372871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2311 RANDOLPH ST",
"city": "CALEDONIA",
"state": "IL",
"postal_code": "610119321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2311 RANDOLPH ST",
"city": "CALEDONIA",
"state": "IL",
"postal_code": "610119321",
"telephone_number": "815-547-1977"
}
],
"practiceLocations": [
{
"address_1": "633 W Perry St",
"address_purpose": "LOCATION",
"city": "Belvidere",
"state": "IL",
"postal_code": "610083153",
"country_code": "US",
"telephone_number": "815-544-9274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEJONG",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-21",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IL",
"license": "1840449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caledonia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.