1932295458 NPI number — DR. DENA JILL KLAPPERICH PSY.D.

Table of content: DR. DENA JILL KLAPPERICH PSY.D. (NPI 1932295458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932295458 NPI number — DR. DENA JILL KLAPPERICH PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLAPPERICH
Provider First Name:
DENA
Provider Middle Name:
JILL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932295458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3012 LIBERTY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDENHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60046-7892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-245-8786
Provider Business Mailing Address Fax Number:
847-549-8006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
977 LAKEVIEW PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-612-7141
Provider Business Practice Location Address Fax Number:
847-549-8006
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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