Active NPI
Jennifer A. Simkins-Bullock, PH.D.
- Clinical Neuropsychologist
- Toledo, OH
National Provider Identifier
1891791422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 4779
- Practice address
- 3949 Sunforest CT
Ste 105
Toledo, OH 43623-4454 - Phone
- (419) 475-8809
- Fax
- (419) 475-8810
- NPI assigned
- Jun 28, 2005
- Reactivated
- Mar 22, 2006
- 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 4779 | OH | Primary |
Addresses
Primary practice location
3949 Sunforest CT
Ste 105
Toledo, OH 43623-4454
Mailing address
3949 Sunforest CT
Ste 105
Toledo, OH 43623-4454
Phone (419) 475-8809
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4779 | OH | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225670400000",
"number": "1891791422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3949 SUNFOREST CT",
"address_2": "STE 105",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436234454",
"telephone_number": "419-475-8809",
"fax_number": "419-475-8810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3949 SUNFOREST CT",
"address_2": "STE 105",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436234454",
"telephone_number": "419-475-8809",
"fax_number": "419-475-8810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMKINS-BULLOCK",
"first_name": "JENNIFER",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-28",
"last_updated": "2008-11-03",
"deactivation_date": "2006-03-17",
"reactivation_date": "2006-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "OH",
"license": "4779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.