Individual provider Active NPI

Kelly Dudle, PSY.D.

  • Clinical Psychologist
  • Arlington Heights, IL
National Provider Identifier
1629124573
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
3233 N Arlington Heights Rd
Suite 208
Arlington Heights, IL 60004-1557
Phone
(847) 632-0334
Fax
(847) 632-1621
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

3233 N Arlington Heights Rd
Suite 208
Arlington Heights, IL 60004-1557

Mailing address

3233 N Arlington Heights Rd
Suite 208
Arlington Heights, IL 60004-1557
Phone (847) 632-0334

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

LicenseStateTypeSpecialty
071006834ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Psychological Services, PC Clinical Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629124573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3233 N ARLINGTON HEIGHTS RD",
            "address_2": "SUITE 208",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041557",
            "telephone_number": "847-632-0334",
            "fax_number": "847-632-1621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3233 N ARLINGTON HEIGHTS RD",
            "address_2": "SUITE 208",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041557",
            "telephone_number": "847-632-0334",
            "fax_number": "847-632-1621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLE",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.