Dennis L. Wack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1083 Issued in CO

Practice address

4045 Wadsworth Blvd
# 308
Wheat Ridge, CO 80033-4642

Phone

(303) 421-1896

Fax

(303) 237-3589

NPI assigned

May 17, 2006

Sex

Male

Sole proprietor

No

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

Practice roles

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

• Dennis L Wack PH.D LLC

  • Adult Mental Health Clinic/Center
  • Wheat Ridge, CO
  • NPI 1366642092
  NPD (past) Authorized official

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188172800000",
    "number": "1487606497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 WADSWORTH BLVD",
            "address_2": "# 308",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334642",
            "telephone_number": "303-421-1896",
            "fax_number": "303-237-3589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 WADSWORTH BLVD",
            "address_2": "# 308",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334642",
            "telephone_number": "303-421-1896",
            "fax_number": "303-237-3589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACK",
        "first_name": "DENNIS",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2007-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "1083",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "1083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kourtney Vollert, LPC
• Lisel Marie Von Duyke
• Elana Voronov, ED.M
• Mikkala Shae Vosmera, FNP
• Michelle Lynn Vrooman, LCSW
• Allyssa Marie Wagenknecht
• Traci Wager, MSW, LSW
• Rebecca Waggoner
• Julu Wagle
• Susan Debra Wagner, M.S.W.

• Clinical Psychologist in Wheat Ridge, CO
• Providers in Wheat Ridge, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.