Ellice Kang

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1979 N Mill St Ste 204
Naperville, IL 60563-8472

Phone

(630) 474-1006

NPI assigned

Sep 12, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gryzbek Therapy Services LLCGroup PAC ID 3476886722, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gryzbek Therapy Services LLC

  • Adult Mental Health Clinic/Center
  • Naperville, IL
  • NPI 1649778994
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1679309850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1979 N MILL ST STE 204",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638472",
            "telephone_number": "630-474-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1979 N MILL ST STE 204",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638472",
            "telephone_number": "630-474-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "ELLICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Kampanatkosol, D.O.
• Bradley V. Kampschroeder, O.D.
• Ingrid Kanady, APN-CNP
• Jyoti Kanda, APN-CNP
• Janice Dianne Kane, D,C,
• Michelle Lynn Kania, MS, ATC
• Theodora K Kanjama, MD
• Sylvia Kanney
• Riddhi Kansara, LPC
• Victoria L Kanter, R.PH.

• Psychologist in Naperville, IL
• Providers in Naperville, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.

Verify at the official NPI Registry.