Kathleen Broderick Woody, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2041-057 Issued in WI

Practice address

2645 N Mayfair Rd
Suite 130
Wauwatosa, WI 53226-1304

Phone

(414) 256-0077

Fax

(414) 256-0090

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Autism Intervention Milwaukee

  • Community/Behavioral Health Agency
  • Wauwatosa, WI
  • NPI 1821312059
  Authorized official Same address or phone

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1568525673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 N MAYFAIR RD",
            "address_2": "SUITE 130",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261304",
            "telephone_number": "414-256-0077",
            "fax_number": "414-256-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 N MAYFAIR RD",
            "address_2": "SUITE 130",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261304",
            "telephone_number": "414-256-0077",
            "fax_number": "414-256-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODY",
        "first_name": "KATHLEEN",
        "middle_name": "BRODERICK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "181-140",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2041-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39707200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammie Ae Wolfe, APNP
• Nathan Wolfrath
• Johanna Anita Wood, PHD
• William Jonathan Wood, MD
• Abigail Marie Woodward, PHARMD
• Dennis Worthington, MD
• Paige Wortman, MS, BCBA
• Erica Jo Wright, LPC-IT
• Kirsten Wright
• James Fan Wu

• Clinical Psychologist in Wauwatosa, WI
• Providers in Wauwatosa, 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 14, 2021; 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.