Individual provider Active NPI

David J Leicht, PHD

  • Psychologist
  • Appleton, WI
National Provider Identifier
1417941071
Registry record updated Nov 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1357 Issued in WI
Practice address
444 N Westhill Blvd
Appleton, WI 54914-5715
Phone
(920) 750-7000
Fax
(920) 364-2451
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1357 WI Primary

Addresses

Primary practice location

444 N Westhill Blvd
Appleton, WI 54914-5715

Mailing address

444 N Westhill Blvd
Appleton, WI 54914-5715
Phone (920) 750-7000

Other practice location 1

1531 S Madison St
Appleton, WI 54915-1800
Phone (920) 730-4411

Other identifiers 1

IdentifierTypeStateIssuer
39078500MedicaidWI

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

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1417941071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 N WESTHILL BLVD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549145715",
            "telephone_number": "920-750-7000",
            "fax_number": "920-364-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 N WESTHILL BLVD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549145715",
            "telephone_number": "920-750-7000",
            "fax_number": "920-364-2451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1531 S Madison St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549151800",
            "country_code": "US",
            "telephone_number": "920-730-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEICHT",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39078500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; 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.