NPIMap

Organization Active NPI

University of Illinois

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1962631010
Registry record updated Jul 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071007706 Issued in IL
Legal business name
UNIVERSITY OF ILLINOIS
Practice address
1747 W Roosevelt Rd
Chicago, IL 60608-1264
Phone
(312) 413-1741
NPI assigned
Jul 10, 2009
Last updated
Jul 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2009

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

Authorized official

Name
Marisela Huerta, PH.D.
Title
Visiting Staff Psychologist
Phone
(312) 413-1741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071007706 IL Primary

Addresses

Primary practice location

1747 W Roosevelt Rd
Chicago, IL 60608-1264

Mailing address

1747 W Roosevelt Rd
Chicago, IL 60608-1264
Phone (312) 413-1741

National Provider Directory

National Provider Directory
Tax ID family
U of I Opthalmology Dep122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247184000000",
    "number": "1962631010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-413-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-413-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-10",
        "last_updated": "2009-07-10",
        "status": "A",
        "authorized_official_last_name": "HUERTA",
        "authorized_official_first_name": "MARISELA",
        "authorized_official_title_or_position": "VISITING STAFF PSYCHOLOGIST",
        "authorized_official_telephone_number": "312-413-1741",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; 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.