Active NPI
Jody Ann Pahlavan, PSYD
- Clinical Psychologist
- Menomonee Falls, WI
National Provider Identifier
1093707044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 19360
- Practice address
- N48W16080 Lone Oak LN
Menomonee Falls, WI 53051-7528 - Phone
- (414) 745-3117
- NPI assigned
- Aug 16, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1694-057 | WI | |
| Clinical Psychologist | 103TC0700X | 19360 | WI | Primary |
Addresses
Primary practice location
N48W16080 Lone Oak LN
Menomonee Falls, WI 53051-7528
Mailing address
N48W16080 Lone Oak LN
Menomonee Falls, WI 53051-7528
Phone (414) 745-3117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39229700 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1694-057 | WI | MD | Psychologist |
| 19360 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760400000000",
"number": "1093707044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N48W16080 LONE OAK LN",
"city": "MENOMONEE FALLS",
"state": "WI",
"postal_code": "530517528",
"telephone_number": "414-745-3117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N48W16080 LONE OAK LN",
"city": "MENOMONEE FALLS",
"state": "WI",
"postal_code": "530517528",
"telephone_number": "414-745-3117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAHLAVAN",
"first_name": "JODY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-16",
"last_updated": "2025-10-14",
"certification_date": "2025-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1694-057",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "19360",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39229700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Menomonee Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.