ILLINOIS STATE UNIVERSITY (NPI# 1770615502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770615502 |
| Entity Type | Organization |
| Organization Name | ILLINOIS STATE UNIVERSITY |
| Other Organization Name | PSYCHOLOGICAL SERVICES CENTER |
| Practice Address |
408 Fairchild Hall Campus Box 4625 Normal IL 61790 |
| Practice Telephone | 3094385629 |
| Practice Fax Number | 3094387476 |
| Mailing Telephone | 3094385629 |
| Mailing Fax Number | 3094387476 |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. BRENDA JANE HUBER (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 3094385629 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
IL | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Psychological Services Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669616983 | Illinois State University | Audiologist-Hearing Aid Fitter | 275 S University St, Campus Box 4720, Normal, IL 61790-4720 | 2009-04-30 |
| 1336216027 | Illinois State University | Clinic/Center | College and University, Suite 2540, Normal, IL 61790-2540 | 2006-11-29 |
| 1952460388 | Illinois State University | Pharmacy | 101 N University St, Normal, IL 61790-2540 | 2006-12-08 |
| Street Address |
408 FAIRCHILD HALL CAMPUS BOX 4625 |
| City | NORMAL |
| State | IL |
| Zip Code | 61790 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124478714 | Noelle Selkow | Specialist/Technologist | 251c Mcormick Hall, Campus Box 5120, Normal, IL 61790 | 2016-06-15 |
| 1679920375 | Yvette Renee Pigman | Nurse Practitioner | 201 North University, Illinois State Studnet Health Services, Normal, IL 61790 | 2016-05-23 |
| 1912263815 | Kelly Haley | Specialist/Technologist | 7130 Horton Fieldhouse, Normal, IL 61790 | 2012-04-04 |
| 1023391331 | Marie Rupert | Pharmacist | 201 N University Street, Normal, IL 61790 | 2011-09-22 |
| 1578161865 | Abigail Hardesty | Nurse Practitioner | 201 Illinois State Univ, Normal, IL 61790-0001 | 2020-10-09 |
| 1245846989 | Susan M Carl | Nurse Practitioner | 201 North University Street, Normal, IL 61790-0001 | 2020-09-18 |
| 1891336277 | Rebecca Ludolph | Registered Nurse | 201 N University, Normal, IL 61790-0001 | 2019-10-07 |
| 1184188633 | Rachel Elizabeth Heinz | Specialist/Technologist | 347 Illinois State Univ, Normal, IL 61790-0001 | 2019-01-29 |
| 1487118063 | Jean Sawyer | Speech-Language Pathologist | Mail Code 4720, Normal, IL 61790-0001 | 2019-01-28 |
| 1063991792 | Emily Hallstein | Speech-Language Pathologist | 211 Rachel Cooper, Normal, IL 61790-0001 | 2018-08-13 |
| Find all providers in zip 61790 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902044688 | Robert Neil Lusk | Psychologist | 1100 Beech St., Bldg. 7, Normal, IL 61761 | 2009-02-03 |
| 1649493131 | Karen Ingrid Mark | Psychologist | 1100 N Beech St, Suite 10, Normal, IL 61761 | 2007-04-11 |
| 1639452139 | Brent Sylvester | Psychologist | 403 W Virginia Ave, Normal, IL 61761-3666 | 2011-09-21 |
| 1134238264 | Christina M. Burchett | Psychologist | 211 Landmark Dr, Suite B4e, Normal, IL 61761-2160 | 2006-08-30 |
| 1144243882 | Jolie M. Hoffmann | Psychologist | 403 W Virginia Ave, Normal, IL 61761-3666 | 2006-07-25 |
| 1013937382 | Judy Ronan Woodburn | Psychologist | 403 W Virginia Ave, Normal, IL 61761-3666 | 2006-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699166 | Jennifer Knuepfer, Psyd, Pllc | Psychologist | 4256 N Ravenswood Ave Ste 305, Chicago, IL 60613-1114 | 2020-11-03 |
| 1104426170 | Grace Giedgowd | Psychologist | 1640 W Division St Apt 205, Chicago, IL 60622-3939 | 2020-10-29 |
| 1417556283 | Kjp Alliance LLC | Psychologist | 16595 W Easton Ave Ste 1, Lincolnshire, IL 60069-2744 | 2020-10-22 |
| 1184223364 | Caroline Elisabeth Fulton | Psychologist | 1739 N Elston Ave, Chicago, IL 60642-1544 | 2020-10-20 |
| 1881293108 | Haley Michelle Sims | Psychologist | 65 E Wacker Pl Ste 300, Chicago, IL 60601-7203 | 2020-10-19 |
| 1083212005 | Amanda Michele Long | Psychologist | 20280 Governors Hwy Ste 105, Olympia Fields, IL 60461-1068 | 2020-10-12 |
| 1285231936 | Qianhui Zhang | Psychologist | 1225 W Morse Ave Apt 403, Chicago, IL 60626-5751 | 2020-10-06 |
| 1316544158 | Nancy Marie Picard | Psychologist | 4885 N Hermitage Ave, Chicago, IL 60640-4104 | 2020-10-05 |
| 1558978379 | Youngok Kim | Psychologist | 1260 Iroquois Ave Ste 204, Naperville, IL 60563-8548 | 2020-09-25 |
| 1861007049 | Heloisa Garman | Psychologist | 800 Elgin Rd Apt 1611, Evanston, IL 60201-5632 | 2020-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.