NPIMap

Individual provider Active NPI

Wanda Denise Dennis, PHD

  • Clinical Psychologist
  • Bingham Farms, MI
National Provider Identifier
1184649378
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301011636 Issued in MI
Practice address
30100 Telegraph Rd
Bingham Farms, MI 48025-4514
Phone
(248) 443-7021
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY003531 GA
Clinical Psychologist 103TC0700X 6301011636 MI Primary

Addresses

Primary practice location

30100 Telegraph Rd
Bingham Farms, MI 48025-4514

Mailing address

1758 Bridgewater Dr
Ypsilanti, MI 48198-3280
Phone (248) 872-5227

Other identifiers 2

IdentifierTypeStateIssuer
VALUEOPTIONSOtherMIBCBC, BCN
2055092OtherMICIGNA

Other names 1

  • Wanda Dennis Joubert Other name

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY003531GAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Michell Myers PC PastSince May 20, 2009 Accepting new patients
MHSP,Inc Clinical Past Accepting new patients

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1184649378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1758 BRIDGEWATER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983280",
            "telephone_number": "248-872-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30100 TELEGRAPH RD",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254514",
            "telephone_number": "248-443-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "WANDA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003531",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC, BCN",
            "identifier": "VALUEOPTIONS",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2055092",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "JOUBERT",
            "middle_name": "DENNIS",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bingham Farms, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.