Active NPI
Jennifer Marie Menold, S.S.P.
- School Psychologist
- Roselle, IL
National Provider Identifier
1710406954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 983777
- Practice address
- 500 W Bryn Mawr Ave
Roselle, IL 60172-2156 - Phone
- (630) 295-5299
- NPI assigned
- Sep 19, 2017
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 983777 | IL | Primary |
Addresses
Primary practice location
500 W Bryn Mawr Ave
Roselle, IL 60172-2156
Mailing address
500 W Bryn Mawr Ave
Roselle, IL 60172-2156
Phone (630) 295-5299
Other practice location 1
600 Medinah Rd
Roselle, IL 60172-2570
Phone (630) 295-5299
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 |
|---|---|---|---|
| 983777 | IL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1710406954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W BRYN MAWR AVE",
"city": "ROSELLE",
"state": "IL",
"postal_code": "601722156",
"telephone_number": "630-295-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W BRYN MAWR AVE",
"city": "ROSELLE",
"state": "IL",
"postal_code": "601722156",
"telephone_number": "630-295-5299"
}
],
"practiceLocations": [
{
"address_1": "600 Medinah Rd",
"address_purpose": "LOCATION",
"city": "Roselle",
"state": "IL",
"postal_code": "601722570",
"country_code": "US",
"telephone_number": "630-295-5299",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MENOLD",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "S.S.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IL",
"license": "983777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roselle, 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.