Stanley Keith Wacholz, BS BIS

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

Practice address

5723 E Dodd Rd
Hayden Lake, ID 83835-9376

Phone

(208) 651-8985

NPI assigned

Sep 26, 2019

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)

Not enrolled

Credentials

Bachelor of Science

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1548811904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5723 E DODD RD",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838359376",
            "telephone_number": "208-651-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5723 E DODD RD",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838359376",
            "telephone_number": "208-651-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHOLZ",
        "first_name": "STANLEY",
        "middle_name": "KEITH",
        "credential": "BS BIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assistant Behavior Analyst in Hayden Lake, ID
• Providers in Hayden Lake, ID by specialty
• Assistant Behavior Analyst in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.