Individual provider Active NPI

Ericka Lisle Wodka, PH.D.

  • Clinical Neuropsychologist
  • Baltimore, MD
National Provider Identifier
1033256342
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
04646 Issued in MD
Practice address
3901 Greenspring Ave
Baltimore, MD 21211-1353
Phone
(443) 923-7717
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 04646 MD Primary

Addresses

Primary practice location

3901 Greenspring Ave
Baltimore, MD 21211-1353

Mailing address

3901 Greenspring Ave
Baltimore, MD 21211-1353
Phone (443) 923-7717

Other names 1

  • Ericka Lisle Anderson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231209000149 MD Practitioner - Clinical Psychologist 6406205921 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
04646MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Krieger Associates CurrentSince Nov 1, 2023 Accepting new patients
Kennedy Krieger Associates CurrentSince Nov 1, 2023 Accepting new patients

Locations

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1741 Ashland Ave
Rm 646
Baltimore, MD 21205
Phone (443) 923-1842

3901 Greenspring Ave
Baltimore, MD 21211
Phone (443) 923-7630

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1033256342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 GREENSPRING AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111353",
            "telephone_number": "443-923-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 GREENSPRING AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111353",
            "telephone_number": "443-923-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WODKA",
        "first_name": "ERICKA",
        "middle_name": "LISLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MD",
            "license": "04646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICKA",
            "last_name": "ANDERSON",
            "middle_name": "LISLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.