Andersonville Psychology, PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009490 Issued in IL

Legal business name

ANDERSONVILLE PSYCHOLOGY, PC

Practice address

5412 N Clark St Ste 220
Chicago, IL 60640-1272

Phone

(773) 985-8746

NPI assigned

Jul 12, 2017

Organization subpart

No

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

Authorized official

Name

Jonathan Smith, PSYDNPI 1124403100

Title

President

Phone

(773) 985-8746

Specialties & licenses 1

Addresses

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Smith, PSYD

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1124403100
  NPD Authorized official
• Diana L Campbell

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1598095499
  NPD (past)
• Jamie Rae Harris, LCPC

  • Professional Counselor
  • Chicago, IL
  • NPI 1124614599
  NPD (past)
• Joanna Nowak, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1265901490
  NPD (past)
• Scott Pasko, LCSW, CADC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1770147308
  NPD (past)

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1962924829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 W FARWELL AVE APT NB",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606266064",
            "telephone_number": "773-985-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 N CLARK ST STE 220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401272",
            "telephone_number": "773-985-8746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSONVILLE PSYCHOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-985-8746",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Ruth Anderson, RDN, LDN
• Andersonville Behavioral Health, LLC (Steven A Migalski)
• Andersonville Counseling Center, LLC
• Andersonville Dental
• Andersonville Physical Therapy, SC
• Gunnar B.J. Andersson, MD
• Claire Anderton, MA
• Alexandra Andes
• David Andes, LCSW
• Niekla Survia Andiesta

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; 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.