Adam Miles Sturdevant, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3638-57 Issued in WI

Practice address

1049 Dousman St
Green Bay, WI 54303-3003

Phone

(920) 888-6868

NPI assigned

May 4, 2009

Last updated

Oct 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Neurofeedback Training Clinics, LLC

  • Multi-Specialty Clinic/Center
  • Green Bay, WI
  • NPI 1427758481
  Authorized official Same address or phone

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

{
    "created_epoch": "1241395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1457585614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 DOUSMAN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033003",
            "telephone_number": "920-888-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 DOUSMAN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033003",
            "telephone_number": "920-888-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURDEVANT",
        "first_name": "ADAM",
        "middle_name": "MILES",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-04",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "14358-130",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3638-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Stubb, OTR/L
• Ashley M Stueber, OT
• Patricia A Stukenberg, APNP
• Jeffery Jon Stumbras, MSW
• Marta Stumbras, PHYSICAL THERAPIST
• Jinxiang Su
• Melissa A Suchalla, LPC
• Pamela Rani Sud, MD
• Sue Huber & Associates, S.C.
• William Halyburton Suits, DPT

• Clinical Psychologist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; 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.