Individual provider Active NPI

Valynda K Wells, PHD

  • Clinical Psychologist
  • Milwaukee, WI
National Provider Identifier
1164480489
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1731 Issued in WI
Practice address
2906 S 20TH St
Milwaukee, WI 53215
Phone
(414) 897-5511
Fax
(414) 385-7552
NPI assigned
May 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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 1731 WI Primary

Addresses

Primary practice location

2906 S 20TH St
Milwaukee, WI 53215

Mailing address

PO Box 778789
Chicago, IL 60677-8789
Phone (414) 672-1353

Other identifiers 2

IdentifierTypeStateIssuer
42490OtherNATIONAL REGISTER OF HEAL
39106000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505001075 WI Practitioner - Clinical Psychologist 1557301876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1731WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
16TH Street Community Health Center Inc. Current Accepting new patients
Sixteenth Street Community Health Centers, Inc. CurrentSince Apr 9, 2024 Accepting new patients

Locations

2906 S 20th St
Milwaukee, WI 53215
Phone (414) 385-8800

4570 S 27th St
Milwaukee, WI 53221
Phone (414) 325-8720

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204

1635 W National Ave
Milwaukee, WI 53204
Phone (262) 408-5094

309 E North St
Waukesha, WI 53188
Phone (262) 408-2530

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1164480489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 778789",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606778789",
            "telephone_number": "414-672-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 S 20TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53215",
            "telephone_number": "414-897-5511",
            "fax_number": "414-385-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "VALYNDA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL REGISTER OF HEAL",
            "identifier": "42490",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39106000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.