MEDICARE: JEM PSYCHOLOGICAL SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	251S00000X	Community/Behavioral Health Agency	071006309	IL

General Provider Information

NPI Number	:	1043474976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEM PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	4001 W DEVON AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	847-542-1265
Fax Number	:	847-620-0634

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	847-542-1265
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. KATHLEEN ANN KRUPICA
Credential	:	PSY.D.
Telephone Number	:	847-542-1265

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	01/16/2025

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