Active NPI
Kyle Wacker
- Social Worker
- Chandler, AZ
National Provider Identifier
1053769075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- D08756225
- Practice address
- 66 S 133Rd St
Chandler, AZ 85225-6014 - Phone
- (480) 204-6542
- NPI assigned
- May 31, 2016
- Last updated
- May 31, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | D08756225 | AZ | Primary |
Addresses
Primary practice location
66 S 133Rd St
Chandler, AZ 85225-6014
Mailing address
66 S 133Rd St
Chandler, AZ 85225-6014
Phone (480) 204-6542
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D08756225 | AZ | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1053769075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 S 133RD ST",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852256014",
"telephone_number": "480-204-6542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 S 133RD ST",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852256014",
"telephone_number": "480-204-6542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACKER",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-31",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AZ",
"license": "D08756225",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.