Active NPI
Katie Rollin, PSY.D.
- Clinical Psychologist
- Green Bay, WI
National Provider Identifier
1063786556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2939-057
- Practice address
- 1160 Kepler Dr
Green Bay, WI 54311-8321 - Phone
- (920) 288-5500
- NPI assigned
- Feb 29, 2012
- Last updated
- Feb 20, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2939-057 | WI | Primary |
Addresses
Primary practice location
1160 Kepler Dr
Green Bay, WI 54311-8321
Mailing address
1160 Kepler Dr
Green Bay, WI 54311-8321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063786556 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2939-057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487548800000",
"number": "1063786556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1160 KEPLER DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543118321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 KEPLER DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543118321",
"telephone_number": "920-288-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLLIN",
"first_name": "KATIE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-29",
"last_updated": "2017-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2939-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1063786556",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.