Gloria Jennings Waterhouse, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY202071 Issued in ID

Practice address

100 N 1St Ave
Sandpoint, ID 83864-1376

Phone

(208) 263-2040

NPI assigned

Oct 24, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Clinical Psychologist

Education

Other, 1981

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Psychological Consultants, PC

  • Clinical Psychologist
  • Sandpoint, ID
  • NPI 1437452828
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289865600000",
    "number": "1174702385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641376",
            "telephone_number": "208-263-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641376",
            "telephone_number": "208-263-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERHOUSE",
        "first_name": "GLORIA",
        "middle_name": "JENNINGS",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-24",
        "last_updated": "2010-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY202071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "10139177",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806574200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "N5327",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wanda G. Fox
• James Wandler, LPC
• Cindy Wanek
• James Russell Wanek, RPH
• Joseph Wassif
• Jeremy J Waters, M.D.
• Kara R Waters, D.O
• Watershed Wellness, LLC
• James Harvey Watts III, M.D.
• Megan Rita Waugaman, PMHNP

• Clinical Psychologist in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.