Active NPI
Matthew William Wadland, PSYD
- Psychologist
- Chicago, IL
National Provider Identifier
1154657377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071007634
- Practice address
- 53 W Jackson Blvd
Suite 602
Chicago, IL 60604 - Phone
- (773) 860-1931
- NPI assigned
- Oct 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071007634 | IL | Primary |
Addresses
Primary practice location
53 W Jackson Blvd
Suite 602
Chicago, IL 60604
Mailing address
4814 N Damen Ave
406
Chicago, IL 60625-4191
Phone (773) 860-1931
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 |
|---|---|---|---|
| 071007634 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256169600000",
"number": "1154657377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4814 N DAMEN AVE",
"address_2": "406",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606254191",
"telephone_number": "773-860-1931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53 W JACKSON BLVD",
"address_2": "SUITE 602",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60604",
"telephone_number": "773-860-1931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADLAND",
"first_name": "MATTHEW",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-22",
"last_updated": "2009-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071007634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.