Jeremy Ryan Fletcher, SSP, NCSP
Individual provider Active NPI School Psychologist · Red Bud, IL
NPI 1972010387 · NPPES record last updated Jan 8, 2018
Key facts
- NPI
- 1972010387
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 1903393 (IL)
- Practice address
- 1525 Locust St
Red Bud, IL 62278-1374 - Phone
- (618) 282-6251
- Fax
- (618) 282-6880
- NPI assigned
- Jan 8, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1903393 | IL | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perandoe Special Education District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1903393 | IL | Yes |
Addresses
Primary practice location
1525 Locust St
Red Bud, IL 62278-1374
Mailing address
1525 Locust St
Red Bud, IL 62278-1374
Phone (618) 282-6251
Other providers in Red Bud, IL
- Earl Gene Draves
- DRS Pichet & Meechai
- Ethan Louis Duclos
- Charmaine E Edwards
- Pamela Elizabeth Ehlers
- Kaitlin Floarke
- Focus Rehabilitation
- Shirley Marie Forcum
- Samantha Garza
- Gibson'S Discount Drugs, Inc
All providers in Red Bud, IL · School Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.