NPIMap

Organization Active NPI

Jane E. Samuelson, PHD, LTD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1972035418
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071-003172 Issued in IL
Legal business name
JANE E. SAMUELSON, PHD, LTD
Practice address
111 North Wabash
Suite 1704
Chicago, IL 60602-1900
Phone
(708) 524-1267
NPI assigned
Apr 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Authorized official

Name
Dr. Jane E. Samuelson, PHD
Title
Owner/Provider
Phone
(708) 524-1267

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071-003172 IL Primary

Addresses

Primary practice location

111 North Wabash
Suite 1704
Chicago, IL 60602-1900

Mailing address

111 North Wabash
Suite 1704
Chicago, IL 60602-1900
Phone (708) 524-1267

National Provider Directory

National Provider Directory

Locations

111 N Wabash Ave
Ste 1704
Chicago, IL 60602
Phone (708) 524-1267

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1972035418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NORTH WABASH",
            "address_2": "SUITE 1704",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021900",
            "telephone_number": "708-524-1267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NORTH WABASH",
            "address_2": "SUITE 1704",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021900",
            "telephone_number": "708-524-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANE E. SAMUELSON, PHD, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "SAMUELSON",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "708-524-1267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-003172",
            "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 Apr 3, 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.