Justin M Wiseman, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2018037238 Issued in MO

Practice address

401 E 19TH St Apt 1405
Kansas City, MO 64108-1791

Phone

(314) 255-9594

NPI assigned

Nov 20, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1073159539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 19TH ST APT 1405",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641081791",
            "telephone_number": "314-255-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 19TH ST APT 1405",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641081791",
            "telephone_number": "314-255-9594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 N Stadium Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652031429",
            "country_code": "US",
            "telephone_number": "314-255-9594",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Fulton",
            "state": "MO",
            "postal_code": "652511753",
            "country_code": "US",
            "telephone_number": "573-592-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 Metropolitan Ave",
            "address_purpose": "LOCATION",
            "city": "Leavenworth",
            "state": "KS",
            "postal_code": "660481254",
            "country_code": "US",
            "telephone_number": "314-255-9594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-20",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2018037238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Wise Sr., LCSW
• Candice Wise, LMSW
• Christopher L Wise, M.D.
• Kaitlyn Wise, PHARMD
• Sareta Wise, LPN
• Kaylee Wisemore
• Donald Benjamin Wisniewski
• Mary K Wissmann
• Lisa Ann Witcher, PSYD
• Joseph W. Witham, MD

• Clinical Psychologist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.