Provider Demographics
NPI:1043474976
Name:JEM PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:JEM PSYCHOLOGICAL SERVICES, PC
Other - Org Name:KATHLEEN KRUPICA, PSY.D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KRUPICA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-542-1265
Mailing Address - Street 1:4055 W PETERSON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6182
Mailing Address - Country:US
Mailing Address - Phone:847-542-1265
Mailing Address - Fax:847-620-0634
Practice Address - Street 1:4055 W PETERSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6182
Practice Address - Country:US
Practice Address - Phone:847-542-1265
Practice Address - Fax:847-620-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006309251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health