Individual
MR. NEIL ALLEN JEPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1111 TRINITY LN STE 111, BLOOMINGTON, IL 61704-8112
(309) 663-6461
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0470000715
VT
103TC0700X
Clinical Psychologist
047000715
VT
103TH0100X
Health Service Psychologist
0470000715
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010983
—
VT
Enumeration date
08/14/2006
Last updated
04/19/2023
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