Unknown Individual – Clinical Psychologist, NPI 1881953651

Unknown Individual is a healthcare provider. based in Pekin, Illinois. specializing in Clinical Psychologist. They hold a License No. 071008345 (IL). The NPI Number for Unknown Individual is 1881953651

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1881953651
Phone
(309) 353-0750
Address
113 N PARKWAY DR
Deactivation Date
13 November 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3097063190
Graduation Year
2010 (16 years ago)
PAC ID
2264696343
Group Practice PAC ID
9739152380
Professional Enrollment ID
I20120621000527
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

  • 113 N PARKWAY DR

    PEKIN, IL 615543932

    Phone: (309) 353-0750

    Type: Mailing

  • 600 S 13TH ST

    SUITE J

    PEKIN, IL 615544936

    Phone: (309) 353-0750

    Type: Location

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.

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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.

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Medicare Utilization (FFS)

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

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

Insurance plans in this area (ZIP 61554)

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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: 9739152380View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1881953651.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Pekin, Illinois. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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