NPIMap

Organization Active NPI

Counseling and Diagnostic Center of Woodfield, LTD.

  • Clinical Psychologist
  • Schaumburg, IL
National Provider Identifier
1821151135
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
COUNSELING AND DIAGNOSTIC CENTER OF WOODFIELD, LTD.
Practice address
1325 Wiley Road
Suite 165
Schaumburg, IL 60173
Phone
(847) 884-0210
Fax
(847) 884-7349
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Authorized official

Name
David R. Jezl, PSY.D.NPI 1053474999
Title
Executive Director
Phone
(847) 884-0210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1325 Wiley Road
Suite 165
Schaumburg, IL 60173

Mailing address

1325 Wiley Road
Suite 165
Schaumburg, IL 60173
Phone (847) 884-0210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060227000502 IL Part B Supplier - Clinic/Group Practice 8729094800 Receives reassigned benefits from 9 practitioners
Practice locations: Schaumburg, IL

National Provider Directory

National Provider Directory

Locations

1325 Wiley Rd
Ste 165
Schaumburg, IL 60173
Phone (847) 884-0210

955 N Plum Grove Rd
Ste C
Schaumburg, IL 60173
Phone (847) 884-0210

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1821151135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 WILEY ROAD",
            "address_2": "SUITE 165",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "60173",
            "telephone_number": "847-884-0210",
            "fax_number": "847-884-7349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 WILEY ROAD",
            "address_2": "SUITE 165",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "60173",
            "telephone_number": "847-884-0210",
            "fax_number": "847-884-7349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING AND DIAGNOSTIC CENTER OF WOODFIELD, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "JEZL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-884-0210",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.