Wahlberg Psychological Services

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

WAHLBERG PSYCHOLOGICAL SERVICES

Practice address

2320 Dean St Ste 201
St Charles, IL 60175-1068

Phone

(630) 776-1181

NPI assigned

Jan 12, 2022

Last updated

Jan 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacey Wahlberg

Title

Manager

Phone

(630) 776-1181

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1427709393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 DEAN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601751068",
            "telephone_number": "630-776-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 DEAN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601751068",
            "telephone_number": "630-776-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHLBERG PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "WAHLBERG",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-776-1181"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; 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.