Unknown Individual – Clinical Psychologist, NPI 1255679544

Unknown Individual is a healthcare provider. based in Naperville, Illinois. specializing in Clinical Psychologist. They hold a License No. 071008584 (IL). The NPI Number for Unknown Individual is 1255679544

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255679544
Phone
(630) 776-4538
Address
143 PIER CT
Deactivation Date
8 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8472598583
Graduation Year
2010 (16 years ago)
PAC ID
6800037250
Group Practice PAC ID
0941100366
Professional Enrollment ID
I20130726000392
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 143 PIER CT

    NAPERVILLE, IL 605651476

    Phone: (630) 776-4538

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60565)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941100366View full group profile

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1255679544.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Clinical Psychologist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Naperville, Illinois may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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