Active NPI
Jordan Stiede
- Psychologist
- Brookfield, WI
National Provider Identifier
1184451650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5205-57
- Practice address
- 15850 W Bluemound Rd Ste 208
Brookfield, WI 53005-6007 - Phone
- (414) 419-4303
- NPI assigned
- Sep 18, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 5205-57 | WI | Primary |
Addresses
Primary practice location
15850 W Bluemound Rd Ste 208
Brookfield, WI 53005-6007
Mailing address
15850 W Bluemound Rd Ste 208
Brookfield, WI 53005-6007
Phone (920) 676-8047
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 |
|---|---|---|---|
| 5205-57 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726617600000",
"number": "1184451650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15850 W BLUEMOUND RD STE 208",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056007",
"telephone_number": "920-676-8047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15850 W BLUEMOUND RD STE 208",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056007",
"telephone_number": "414-419-4303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STIEDE",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-18",
"last_updated": "2024-09-18",
"certification_date": "2024-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "5205-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.