| Jodi M Fourt | |
|
1530 N Randall Rd Ste 220 Elgin IL 60123-7879 | |
| (224) 703-5595 | |
| Not Available |
| Full Name | Jodi M Fourt |
|---|---|
| Speciality | Psychologist |
| Location | 1530 N Randall Rd Ste 220, Elgin, Illinois |
| Authorized Official Name and Position | Jodi Fourt (SOLE PROPRIETOR/PSYD) |
| Authorized Official Contact | 2247035595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi M Fourt 13 Crossview Ct Lake In The Hills IL 60156-5841 Ph: (224) 703-5595 | Jodi M Fourt 1530 N Randall Rd Ste 220 Elgin IL 60123-7879 Ph: (224) 703-5595 |
| NPI Number | 1376235184 |
|---|---|
| Provider Enumeration Date | 05/22/2023 |
| Last Update Date | 05/22/2023 |
| Certification Date | 05/22/2023 |
| Medicare PECOS PAC ID | 3072950773 |
|---|---|
| Medicare Enrollment ID | O20240318000568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376235184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jodi M Fourt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053662445 PECOS PAC ID: 5294153110 Enrollment ID: I20200909002063 |
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