Danielle E Sample, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2476-057 Issued in WI

Practice address

161 W Wisconsin Ave Ste 2B
Pewaukee, WI 53072-3468

Phone

(262) 695-8857

Fax

(262) 695-8879

NPI assigned

Jun 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lakefront Wellness Center, SC

  • Clinical Psychologist
  • Pewaukee, WI
  • NPI 1316024847
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548205685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W243N5807 QUAIL RUN LN",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530893680",
            "telephone_number": "262-695-8857",
            "fax_number": "262-695-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 W WISCONSIN AVE STE 2B",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530723468",
            "telephone_number": "262-695-8857",
            "fax_number": "262-695-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "DANIELLE",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2476-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40906600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "392929500010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roundys Supermarkets Inc (Pick N Save Pharmacy)
• Molly Rae Rubel, MS LMFT
• Nickolas Rukamp, PA-C
• Sabra Wisconsin Operations II, LLC
• Sarita Odessa Salamone, BCTMB, LMT
• Jill San Agustin, C.A., MSOM, BS
• Adam Joseph Sangermano, ABOC
• Shawn Michael Sanicola, DPM
• Laurie Jean Sasso, LCSW
• Rosita Saya-Ang

• Clinical Psychologist in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.