Active NPI
Phillip Loren Zediker, PH D
- Clinical Psychologist
- Bradley, IL
National Provider Identifier
1912018383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071001596
- Practice address
- 525 E North St Ste B
Bradley, IL 60915-1186 - Phone
- (815) 933-0667
- Fax
- (815) 933-0665
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071001596 | IL | Primary |
Addresses
Primary practice location
525 E North St Ste B
Bradley, IL 60915-1186
Mailing address
525 E North St Ste B
Bradley, IL 60915-1186
Phone (815) 933-0667
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 |
|---|---|---|---|
| 071001596 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1912018383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 E NORTH ST STE B",
"city": "BRADLEY",
"state": "IL",
"postal_code": "609151186",
"telephone_number": "815-933-0667",
"fax_number": "815-933-0665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 E NORTH ST STE B",
"city": "BRADLEY",
"state": "IL",
"postal_code": "609151186",
"telephone_number": "815-933-0667",
"fax_number": "815-933-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZEDIKER",
"first_name": "PHILLIP",
"middle_name": "LOREN",
"name_prefix": "Dr.",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071001596",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.