Active NPI
Sandra Jean Wynn-Stelt, MA LLP BCBA
- Intellectual & Developmental Disabilities Psychologist
- Grand Rapids, MI
National Provider Identifier
1033398581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- License
- 6301008405
- Practice address
- 680 3 Mile Rd NW
Suite C
Grand Rapids, MI 49544-8218 - Phone
- (616) 647-3460
- Fax
- (616) 647-3467
- NPI assigned
- Nov 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-14-15612 | MI | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 6301008405 | MI | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 6301008405 | MI | Primary |
Addresses
Primary practice location
680 3 Mile Rd NW
Suite C
Grand Rapids, MI 49544-8218
Mailing address
680 3 Mile Rd NW
Suite C
Grand Rapids, MI 49544-8218
Phone (616) 647-3460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008405 | MI | MD | Intellectual & Developmental Disabilities Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kent County CMH Authority | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Grand Rapids, MI
- NPI 1194617811
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587081600000",
"number": "1033398581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 3 MILE RD NW",
"address_2": "SUITE C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495448218",
"telephone_number": "616-647-3460",
"fax_number": "616-647-3467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 3 MILE RD NW",
"address_2": "SUITE C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495448218",
"telephone_number": "616-647-3460",
"fax_number": "616-647-3467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN-STELT",
"first_name": "SANDRA",
"middle_name": "JEAN",
"credential": "MA LLP BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-01",
"last_updated": "2020-04-17",
"certification_date": "2020-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "1-14-15612",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MI",
"license": "6301008405",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "MI",
"license": "6301008405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.