Wanda Denise Smith, CPSYC HCPROF

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

8KUSC7H7 Issued in IL

Practice address

17100 Dixie Hwy Ste D
Hazel Crest, IL 60429-1485

Phone

(331) 643-5238

Fax

(708) 991-7320

NPI assigned

Feb 12, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Denise Smith Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Near North Health Service Corporation

  • Public Health or Welfare Agency
  • Chicago, IL
  • NPI 1033838214
  Authorized official Same address or phone
• New Hope Community Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Justice, IL
  • NPI 1063642841
  Authorized official Same address or phone
• New Hope Community Service Center

  • Non-emergency Medical Transport (VAN)
  • Justice, IL
  • NPI 1508700345
  Authorized official Same address or phone
• New Hope Community Service Center

  • Doula
  • Chicago, IL
  • NPI 1710848932
  Authorized official Same address or phone
• New Hope Community Service Center

  • Behavior Analyst
  • Houston, TX
  • NPI 1528904778
  NPD

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1114550688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11344 S HERMOSA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434279",
            "telephone_number": "331-643-5238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 DIXIE HWY STE D",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291485",
            "telephone_number": "331-643-5238",
            "fax_number": "708-991-7320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11344 S Hermosa Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606434279",
            "country_code": "US",
            "telephone_number": "331-643-5238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WANDA DENISE",
        "credential": "CPSYC HCPROF",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "KWN75FB9",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IL",
            "license": "8KUSC7H7",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "IL",
            "license": "8KUSC7H7",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "8KUSC7H7",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36369473001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DENISE",
            "last_name": "SMITH",
            "credential": "CPSYC HCPROF",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tessa Singer, RD
• Tanyalak Sivabovorn, M.D.
• Skylight Ascend Wellness, PLLC
• Smith Thomas-Williams Healthcare, LLC (STW Home Health)
• Elizy Smith, SLP
• Sole 2 Sole, PC (Dr. Eveleigh Williams)
• Jack Lamont Solomon Jr.
• South Suburban Senior Socialites, Inc
• Southwest Eye Center, S.C.
• Olalekan Sowade, M.D.

• Clinical Psychologist in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.

Verify at the official NPI Registry.