| Peoria Psychological Associates, P.c. | |
|
5505 N Fairmont Dr Peoria IL 61614-4246 | |
| (309) 689-6700 | |
| (309) 689-0774 |
| Full Name | Peoria Psychological Associates, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 5505 N Fairmont Dr, Peoria, Illinois |
| Authorized Official Name and Position | Jane Velez (OWNER, CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3096896700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peoria Psychological Associates, P.c. 5505 N Fairmont Dr Peoria IL 61614-4246 Ph: (309) 689-6700 | Peoria Psychological Associates, P.c. 5505 N Fairmont Dr Peoria IL 61614-4246 Ph: (309) 689-6700 |
| NPI Number | 1427021393 |
|---|---|
| Provider Enumeration Date | 02/09/2006 |
| Last Update Date | 04/12/2012 |
| Medicare PECOS PAC ID | 1153582580 |
|---|---|
| Medicare Enrollment ID | O20120412000127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427021393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071005320 (Illinois) | Primary |
| 103TF0200X | Psychologist - Forensic | 14987 (Illinois) | Secondary |
| Provider Name | Jane H Velez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699781260 PECOS PAC ID: 1254436801 Enrollment ID: I20070410000657 |
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