Active NPI
Jaime Boudros Mossman
- Developmental Therapist
- Villa Park, IL
National Provider Identifier
1972624609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- JB23770301P
- Practice address
- 32 S Charles Ave
Villa Park, IL 60181-2618 - Phone
- (630) 204-3366
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | JB23770301P | IL | Primary |
Addresses
Primary practice location
32 S Charles Ave
Villa Park, IL 60181-2618
Mailing address
32 S Charles Ave
Villa Park, IL 60181-2618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JB23770301P | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972624609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 S CHARLES AVE",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601812618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 S CHARLES AVE",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601812618",
"telephone_number": "630-204-3366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSSMAN",
"first_name": "JAIME",
"middle_name": "BOUDROS",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "JB23770301P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.