Active NPI
David J. Wakely, PH.D.
- Clinical Psychologist
- Janesville, WI
National Provider Identifier
1134228802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2711-057
- Practice address
- 557 N Washington St
Janesville, WI 53548 - Phone
- (608) 754-6000
- Fax
- (608) 755-7892
- NPI assigned
- Sep 21, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071-002790 | IL | |
| Clinical Psychologist | 103TC0700X | 2711-057 | WI | Primary |
Addresses
Primary practice location
557 N Washington St
Janesville, WI 53548
Mailing address
557 N Washington St
Janesville, WI 53548-2907
Phone (608) 754-6000
Other practice location 1
1000 Mineral Point Ave
Mercy Health System
Janesville, WI 53548-2940
Phone (608) 756-6000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134228802 | Medicaid | WI | |
| P00684638CD3624 | Other | WI | RR MEDICARE |
| 541760589 | Other | WI | WI MEDICARE |
| WAKELDAV | Other | WI | MERCYCARE INSURANCE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-002790 | IL | MD | Clinical Psychologist |
| 2711-057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528934400000",
"number": "1134228802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "557 N WASHINGTON ST",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535482907",
"telephone_number": "608-754-6000",
"fax_number": "608-755-7892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "557 N WASHINGTON ST",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "53548",
"telephone_number": "608-754-6000",
"fax_number": "608-755-7892"
}
],
"practiceLocations": [
{
"address_1": "1000 Mineral Point Ave",
"address_2": "Mercy Health System",
"address_purpose": "LOCATION",
"city": "Janesville",
"state": "WI",
"postal_code": "535482940",
"country_code": "US",
"telephone_number": "608-756-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAKELY",
"first_name": "DAVID",
"middle_name": "J.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2018-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-002790",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2711-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1134228802",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00684638CD3624",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI MEDICARE",
"identifier": "541760589",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE INSURANCE",
"identifier": "WAKELDAV",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
- Dorothy Renee Waddell, PTA
- Treashure Wade, PHARM.D.
- John Patrick Wagener, DC
- Patrick John Wagener, DC
- Richard K Wagner, MD
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1305)
- Wal-Mart Stores East, LP (Vision Center 30-1305)
- Denise Sue Walder, OT
- Walgreen Co (Walgreens #11235)
- Walgreen Co (Walgreens #13613)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.