Dana R Wackerly, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY14648 Issued in CA

Practice address

3445 American River Dr
Suite B
Sacramento, CA 95864-5744

Phone

(916) 973-8928

Fax

(916) 974-1867

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497970180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3445 AMERICAN RIVER DR",
            "address_2": "SUITE B",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958645744",
            "telephone_number": "916-973-8928",
            "fax_number": "916-974-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3445 AMERICAN RIVER DR",
            "address_2": "SUITE B",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958645744",
            "telephone_number": "916-973-8928",
            "fax_number": "916-974-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKERLY",
        "first_name": "DANA",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY14648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Vy, MD
• Vyas Medical Corp
• W.H.C., Inc
• Karen Wachtel, MFT-I, CATC
• Brigette Christine Wacker
• Weddell Ornette Waddell
• Ariana Wade, MA
• Autumn Rose Wade
• Brandi Katelyn Wade
• Dianna Lin-Spencer Wade

• Clinical Psychologist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.