Individual provider Active NPI

Daniel C Condit, PHD

  • Clinical Neuropsychologist
  • Appleton, WI
National Provider Identifier
1497992705
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2772-057 Issued in WI
Practice address
5643 W Waterford LN
Appleton, WI 54913-8438
Phone
(920) 404-2100
NPI assigned
Jan 9, 2009
Last updated
Jan 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2772-057 WI Primary

Addresses

Primary practice location

5643 W Waterford LN
Appleton, WI 54913-8438

Mailing address

444 N Westhill Blvd
Thedacare Behavioral Health
Appleton, WI 54914-5715
Phone (920) 720-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20090218000403 WI Practitioner - Clinical Psychologist 8628133089 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2772-057WIMDClinical Neuropsychologist
2772WIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Wisconsin Wellness MH, LLC CurrentSince Aug 21, 2025 Accepting new patients

Locations

5643 W Waterford Ln
Grand Chute, WI 54913
Phone (920) 404-2100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1497992705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 N WESTHILL BLVD",
            "address_2": "THEDACARE BEHAVIORAL HEALTH",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549145715",
            "telephone_number": "920-720-2300",
            "fax_number": "920-720-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5643 W WATERFORD LN",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138438",
            "telephone_number": "920-404-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDIT",
        "first_name": "DANIEL",
        "middle_name": "C",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-09",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "2772-057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.