Health Providers

Primary specialty

PsychoanalystTaxonomy code 102L00000X

License

036055359 Issued in IL

Legal business name

HEALTH PROVIDERS

Practice address

19330 S Cottage Grove Ave
Glenwood, IL 60425-1834

Phone

(708) 758-6200

NPI assigned

Sep 18, 2008

Last updated

Sep 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Keith O Roper, M.D, M.S

Title

Owner

Phone

(312) 421-3434

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1891944484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606073120",
            "telephone_number": "312-421-3434",
            "fax_number": "312-421-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19330 S COTTAGE GROVE AVE",
            "city": "GLENWOOD",
            "state": "IL",
            "postal_code": "604251834",
            "telephone_number": "708-758-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH PROVIDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-18",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "ROPER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-421-3434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D, M.S"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychoanalyst",
            "state": "IL",
            "license": "036055359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ontonio Jackson-Lucas
• Gretchen Jackson

• Psychoanalyst in Glenwood, IL
• Providers in Glenwood, IL by specialty
• Psychoanalyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.

Verify at the official NPI Registry.