Jordan Mallery

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1190 E Washington St
Grayslake, IL 60030-7960

Phone

(847) 549-2235

NPI assigned

Oct 3, 2023

Last updated

Oct 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Counseling Center of Grayslake LTD.

  • Clinical Social Worker
  • Grayslake, IL
  • NPI 1194267385
  NPD

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1891575254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 E WASHINGTON ST",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 E WASHINGTON ST",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307960",
            "telephone_number": "847-549-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLERY",
        "first_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma A Macdougall, LCPC, ATR-BC
• Hetty M. Macdowell, LMT
• Ariel Magallon, MD
• Nicholas Emile Maldonado
• Krithika Malhotra, PHD
• Robert G Malloy, MD
• Manjote K Dhaliwal DDS PC
• Anna Maria Mankowska, M.A.
• Christopher Manning, L.AC.
• Tina Yun Mantanona, MD

• Counselor in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.