=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386913135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D.A. JOPP & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2011
-----------------------------------------------------
Last Update Date | 12/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 W BELMONT AVE SUITE 504
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-355-3112
-----------------------------------------------------
Fax | 815-521-1889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 613
-----------------------------------------------------
City | CHANNAHON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60410-0613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-521-1889
-----------------------------------------------------
Fax | 815-521-1889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID JOPP
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 224-355-3112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071006401
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------