Active NPI
Shannon Skaistis, PHD
- Psychologist
- Wausau, WI
National Provider Identifier
1457171514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 532457
- Practice address
- 630 S 36TH Ave
Wausau, WI 54401-3930 - Phone
- (414) 301-1060
- NPI assigned
- Oct 14, 2024
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 532457 | WI | Primary |
Addresses
Primary practice location
630 S 36TH Ave
Wausau, WI 54401-3930
Mailing address
630 S 36TH Ave
Wausau, WI 54401-3930
Phone (414) 301-1060
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 |
|---|---|---|---|
| 532457 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739923200000",
"number": "1457171514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 S 36TH AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013930",
"telephone_number": "414-301-1060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S 36TH AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013930",
"telephone_number": "414-301-1060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKAISTIS",
"first_name": "SHANNON",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2024-10-14",
"last_updated": "2025-02-19",
"certification_date": "2025-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "532457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.