Bryn W Jessup, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071003787 Issued in IL

Practice address

778 W Frontage Rd
114
Northfield, IL 60093-1209

Phone

(847) 501-5897

Fax

(847) 501-5896

NPI assigned

Oct 10, 2012

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Bryn W. Jessup, PHD, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northfield, IL
  • NPI 1235357849
  NPD (past) Authorized official

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1942552245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "778 W FRONTAGE RD",
            "address_2": "114",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600931209",
            "telephone_number": "847-501-5897",
            "fax_number": "847-501-5896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "778 W FRONTAGE RD",
            "address_2": "114",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600931209",
            "telephone_number": "847-501-5897",
            "fax_number": "847-501-5896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESSUP",
        "first_name": "BRYN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Agatha Jefferson, FNP
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• Jewish Child and Family Services
• Nelly P Jimenez
• Jeremy Johnson
• Mary Jones
• K Chan Dental, P.C.

• Clinical Psychologist in Northfield, IL
• Providers in Northfield, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.

Verify at the official NPI Registry.