Gerald L. Wingard, PH.D.
Individual provider Active NPI Psychologist · Goshen, IN
NPI 1164531091 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164531091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 20040098 (IN)
- Practice address
- 23350 County Road 38
Goshen, IN 46526-9384 - Phone
- (574) 862-3100
- Fax
- (574) 862-4900
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040098 | IN | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20040098 | IN | Yes |
Addresses
Primary practice location
23350 County Road 38
Goshen, IN 46526-9384
Mailing address
23350 County Road 38
Goshen, IN 46526-9384
Phone (574) 862-3100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000176605 | Other | IN | ANTHEM BLUECROSS & BLUE S |
Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.