Individual provider Active NPI

Heather Eve Wedgle, PSY.D.

  • Clinical Psychologist
  • Denver, CO
National Provider Identifier
1154596617
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3350 Issued in CO
Practice address
4495 Hale Pkwy Ste 110
Denver, CO 80220-6203
Phone
(720) 581-4620
Fax
(303) 923-8600
NPI assigned
Apr 25, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3350 CO Primary

Addresses

Primary practice location

4495 Hale Pkwy Ste 110
Denver, CO 80220-6203

Mailing address

521 S Magnolia LN
Denver, CO 80224-1524
Phone (720) 581-4620

Other practice location 1

10201 E 3rd Ave
Aurora, CO 80010-4301
Phone (303) 364-3364

Other identifiers 2

IdentifierTypeStateIssuer
12089362OtherCOCAQH PIN
PSY.0003350OtherCOPROFESSIONAL LICENSE

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

LicenseStateTypeSpecialty
3350COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr, Heather Wedgle, Psy.D., LLC Clinical PastSince Jan 10, 2021 Accepting new patients
Women'S Mental Health Associates, PC PastSince Nov 1, 2015 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1154596617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 S MAGNOLIA LN",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802241524",
            "telephone_number": "720-581-4620",
            "fax_number": "303-923-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4495 HALE PKWY STE 110",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802206203",
            "telephone_number": "720-581-4620",
            "fax_number": "303-923-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10201 E 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800104301",
            "country_code": "US",
            "telephone_number": "303-364-3364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEDGLE",
        "first_name": "HEATHER",
        "middle_name": "EVE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-25",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PIN",
            "identifier": "12089362",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "PSY.0003350",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.