Kenneth Vicencio, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071009682 Issued in IL

Practice address

10730 W 143Rd St Ste 37
Orland Park, IL 60462-1940

Phone

(800) 564-0863

NPI assigned

Aug 22, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1891211710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730 W 143RD ST STE 37",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604621940",
            "telephone_number": "800-564-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 W 143RD ST STE 37",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604621940",
            "telephone_number": "800-564-0863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 W Lake Cook Rd Ste 355",
            "address_purpose": "LOCATION",
            "city": "Buffalo Grove",
            "state": "IL",
            "postal_code": "600891991",
            "country_code": "US",
            "telephone_number": "800-564-0863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICENCIO",
        "first_name": "KENNETH",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-22",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071009682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ted Vellos, M.D.
• Venticare, LLC
• Noelle Nicole Veome
• Claudia Lorena Vergara, M.D.
• Vertex Anesthesia LLC
• Vanessa Vickers, D.C.
• Sara Vickery, MS CCC-SLP/L
• Buen Vidad
• Vijayalakshmi Thota DO
• Vijayalakshmi Thota DO SC

• Clinical Neuropsychologist in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.