Active NPI
Loretta Jean Jendryka, LCPC
- Professional Counselor
- Dekalb, IL
National Provider Identifier
1568664902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180004339
- Practice address
- 12 Health Services Dr
Dekalb, IL 60115-9637 - Phone
- (815) 756-4875
- Fax
- (815) 756-2944
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180004339 | IL | Primary |
Addresses
Primary practice location
12 Health Services Dr
Dekalb, IL 60115-9637
Mailing address
12 Health Services Dr
Dekalb, IL 60115-9637
Phone (815) 756-4875
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260213003090 | IL | Practitioner - Mental Health Counselor | 9830679315 | Practice locations: Palatine, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1974
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1450 Wing St
Apt 1B
Elgin, IL 60123-2746
579 N 1St Bank Dr
Suite 150
Palatine, IL 60067-8102
Phone (847) 794-8836
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180004339 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568664902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 HEALTH SERVICES DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159637",
"telephone_number": "815-756-4875",
"fax_number": "815-756-2944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 HEALTH SERVICES DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159637",
"telephone_number": "815-756-4875",
"fax_number": "815-756-2944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENDRYKA",
"first_name": "LORETTA",
"middle_name": "JEAN",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180004339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.