Jordan M Wisner, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

444 W Fort St FL 2
Boise, ID 83702-4535

Phone

(208) 422-1018

NPI assigned

Dec 20, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1255847786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 W FORT ST FL 2",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024535",
            "telephone_number": "208-422-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 W FORT ST FL 2",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024535",
            "telephone_number": "208-422-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNER",
        "first_name": "JORDAN",
        "middle_name": "M",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-20",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wisconsin Lutheran Child & Family Servic, Ince
• Aaron Wise
• Nancy Jane Wise
• Megan Kae Wiskirchen, M.S., CCC-SLP
• Rebecca S Wiskus, LMSW
• Cody Elijah Wissenbach, P.A.
• Sydney Wiswell
• Emily Remington Withers, LMSW
• Erica Withrow
• Nancy Elizabeth Witman, FNP, MSN

• Psychologist in Boise, ID
• Providers in Boise, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.