Active NPI
Jill Landerholm, PH.D.
- Clinical Psychologist
- Sacramento, CA
National Provider Identifier
1962623629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY16984
- Practice address
- 949 University Ave Ste 200
Sacramento, CA 95825-6728 - Phone
- (916) 599-3004
- NPI assigned
- May 1, 2007
- 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 Psychologist | 103TC0700X | PSY16984 | CA | Primary |
Addresses
Primary practice location
949 University Ave Ste 200
Sacramento, CA 95825-6728
Mailing address
949 University Ave Ste 200
Sacramento, CA 95825-6728
Phone (916) 599-3004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2015 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16984 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1962623629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "949 UNIVERSITY AVE STE 200",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958256728",
"telephone_number": "916-599-3004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "949 UNIVERSITY AVE STE 200",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958256728",
"telephone_number": "916-599-3004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDERHOLM",
"first_name": "JILL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2022-01-26",
"certification_date": "2022-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY16984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.