Active NPI
Jo Sack, LCPC
- Professional Counselor
- Peoria, IL
National Provider Identifier
1891702155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180004604
- Practice address
- 6615 N Big Hollow Rd
Peoria, IL 61615-2450 - Phone
- (309) 692-6622
- NPI assigned
- Aug 1, 2006
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180004604 | IL | Primary |
Addresses
Primary practice location
6615 N Big Hollow Rd
Peoria, IL 61615-2450
Mailing address
6615 N Big Hollow Rd
Peoria, IL 61615-2450
Phone (309) 692-6622
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180004604 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353024000000",
"number": "1891702155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6615 N BIG HOLLOW RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616152450",
"telephone_number": "309-692-6622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6615 N BIG HOLLOW RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616152450",
"telephone_number": "309-692-6622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SACK",
"first_name": "JO",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2012-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180004604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.