Active NPI
Marc W Zylstra, PH.D.
- Group Psychotherapy Psychologist
- Wauwatosa, WI
National Provider Identifier
1295847002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Group Psychotherapy Psychologist
- License
- 1817-057
- Practice address
- 2525 N Mayfair Rd
Suite 200
Wauwatosa, WI 53226-1403 - Phone
- (414) 476-8183
- Fax
- (414) 476-8465
- NPI assigned
- Aug 31, 2006
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1817-057 | WI | |
| Health Service Psychologist | 103TH0100X | 43715 | WI | |
| Psychologist | 103T00000X | 1817-057 | WI | |
| Group Psychotherapy Psychologist | 103TP2701X | 1817-057 | WI | Primary |
Addresses
Primary practice location
2525 N Mayfair Rd
Suite 200
Wauwatosa, WI 53226-1403
Mailing address
2525 N Mayfair Rd
Suite 200
Wauwatosa, WI 53226-1403
Phone (414) 476-8183
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21280000 | Medicaid | WI | |
| 39640900 | Medicaid | WI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1817-057 | WI | MD | Clinical Psychologist |
| 43715 | WI | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1295847002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 N MAYFAIR RD",
"address_2": "SUITE 200",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532261403",
"telephone_number": "414-476-8183",
"fax_number": "414-476-8465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 N MAYFAIR RD",
"address_2": "SUITE 200",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532261403",
"telephone_number": "414-476-8183",
"fax_number": "414-476-8465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZYLSTRA",
"first_name": "MARC",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1817-057",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "WI",
"license": "43715",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1817-057",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "WI",
"license": "1817-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "21280000",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39640900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.