Active NPI
Misty Marie Mann, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1710397997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008814
- Practice address
- 222 Merchandise Mart PLZ Ste 1358
Chicago, IL 60654-1103 - Phone
- (317) 752-0301
- NPI assigned
- Apr 28, 2014
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008814 | IL | Primary |
Addresses
Primary practice location
222 Merchandise Mart PLZ Ste 1358
Chicago, IL 60654-1103
Mailing address
222 Merchandise Mart PLZ Ste 1358
Chicago, IL 60654-1103
Phone (317) 752-0301
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 |
|---|---|---|---|
| 071008814 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398643200000",
"number": "1710397997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 MERCHANDISE MART PLZ STE 1358",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606541103",
"telephone_number": "317-752-0301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 MERCHANDISE MART PLZ STE 1358",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606541103",
"telephone_number": "317-752-0301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "MISTY",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-28",
"last_updated": "2014-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.