Active NPI
Connie Kellogg, PSYCHOLOGIST
- Cognitive & Behavioral Psychologist
- Sebastopol, CA
National Provider Identifier
1821147158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- PSY 8554
- Practice address
- 6756 Walker Ave
Sebastopol, CA 95472-4213 - Phone
- (707) 823-0143
- Fax
- (707) 823-0143
- NPI assigned
- Jan 9, 2007
- 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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY 8554 | CA | Primary |
Addresses
Primary practice location
6756 Walker Ave
Sebastopol, CA 95472-4213
Mailing address
6756 Walker Ave
Sebastopol, CA 95472-4213
Phone (707) 823-0143
Other names 1
- Connie Skillman
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 |
|---|---|---|---|
| PSY 8554 | CA | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424649600000",
"number": "1821147158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6756 WALKER AVE",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724213",
"telephone_number": "707-823-0143",
"fax_number": "707-823-0143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6756 WALKER AVE",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724213",
"telephone_number": "707-823-0143",
"fax_number": "707-823-0143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLOGG",
"first_name": "CONNIE",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2015-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "CA",
"license": "PSY 8554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CONNIE",
"last_name": "SKILLMAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.