Jason Todd Holdeman, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-006876 Issued in IL

Practice address

3420 Illinois St
Great Lakes, IL 60088-3161

Phone

(847) 688-6755

Fax

(847) 688-7411

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1952385148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MISTY HILL LN",
            "city": "HAINESVILLE",
            "state": "IL",
            "postal_code": "600301078",
            "telephone_number": "630-621-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 ILLINOIS ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883161",
            "telephone_number": "847-688-6755",
            "fax_number": "847-688-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDEMAN",
        "first_name": "JASON",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041693A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Paul Haxton, D.D.S
• Marla Crill Heller, R.D.
• Michael Joseph Herriges, D.D.S.
• Jennifer Morgan Hirsh, PHARMD
• Scott Hocker, DDS
• Moses Hollingsworth, D.D.S.
• Cheyne Ian Yueji Horie, DDS
• Daniel Howard, D.D.S.
• Raymond Lawrence Howard Sr.
• Rodger M Howard, IDC

• Clinical Psychologist in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.