Active NPI
Wendy Ellen Goetz, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1164765624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2094
- Practice address
- 405 N Wabash Ave
Suite 912
Chicago, IL 60611-3591 - Phone
- (773) 501-2157
- NPI assigned
- Apr 3, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2094 | KS | Primary |
Addresses
Primary practice location
405 N Wabash Ave
Suite 912
Chicago, IL 60611-3591
Mailing address
405 N Wabash Ave
Suite 912
Chicago, IL 60611-3591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 15, 2025 through Jan 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1164765624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 N WABASH AVE",
"address_2": "SUITE 912",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 N WABASH AVE",
"address_2": "SUITE 912",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113591",
"telephone_number": "773-501-2157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZ",
"first_name": "WENDY",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-03",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "2094",
"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 Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.