Active NPI
Michael Daehn IV
- Clinical Psychologist
- Oshkosh, WI
National Provider Identifier
1417015025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1388-057
- Practice address
- 220 Washington Ave
Oshkosh, WI 54901-5030 - Phone
- (920) 236-4600
- NPI assigned
- Dec 5, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1388-057 | WI | Primary |
Addresses
Primary practice location
220 Washington Ave
Oshkosh, WI 54901-5030
Mailing address
PO Box 2187
Oshkosh, WI 54903-2187
Phone (920) 236-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42139300 | 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 |
|---|---|---|---|
| 1388-057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205798400000",
"number": "1417015025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2187",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549032187",
"telephone_number": "920-236-4600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 WASHINGTON AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549015030",
"telephone_number": "920-236-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAEHN",
"first_name": "MICHAEL",
"name_suffix": "IV",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2008-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1388-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42139300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.