Active NPI
Krystin Wessner, PSY.D.
- Clinical Child & Adolescent Psychologist
- Ellicott City, MD
National Provider Identifier
1275902801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 05642
- Practice address
- 4785 Dorsey Hall Dr
Suite 109
Ellicott City, MD 21042-7728 - Phone
- (410) 531-5087
- NPI assigned
- Sep 24, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05642 | MD | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 05642 | MD | Primary |
Addresses
Primary practice location
4785 Dorsey Hall Dr
Suite 109
Ellicott City, MD 21042-7728
Mailing address
6311 Kiteline CT
Columbia, MD 21044-3805
Phone (509) 654-5710
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 |
|---|---|---|---|
| 05642 | MD | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456185600000",
"number": "1275902801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6311 KITELINE CT",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443805",
"telephone_number": "509-654-5710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4785 DORSEY HALL DR",
"address_2": "SUITE 109",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210427728",
"telephone_number": "410-531-5087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WESSNER",
"first_name": "KRYSTIN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-24",
"last_updated": "2016-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05642",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "05642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.