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General NPI Number Information
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NPI Number | 1043474976
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Entity Type | Organization
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Legal Business Name | JEM PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 4001 W DEVON AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60646-4537
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Country | US
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Telephone | 847-542-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 W DEVON AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60646-4537
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Country | US
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Telephone | 847-542-1265
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Fax | 847-620-0634
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATHLEEN ANN KRUPICA
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Credential | PSY.D.
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Telephone | 847-542-1265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 071006309
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License Number State | IL
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