Active NPI
Kathleen Marie Roy, HSPP
- Clinical Psychologist
- Fort Wayne, IN
National Provider Identifier
1578550513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041032A
- Practice address
- 2100 Goshen Rd
Fort Wayne, IN 46808-1493 - Phone
- (260) 471-3500
- Fax
- (260) 471-4263
- NPI assigned
- Oct 4, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20041032A | IN | Primary |
Addresses
Primary practice location
2100 Goshen Rd
Fort Wayne, IN 46808-1493
Mailing address
850 N Harrison St
Attn: Anne Lawson
Warsaw, IN 46580-3163
Phone (574) 267-7169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200100610A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041032A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290124800000",
"number": "1578550513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 N HARRISON ST",
"address_2": "ATTN: ANNE LAWSON",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803163",
"telephone_number": "574-267-7169",
"fax_number": "574-268-2377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 GOSHEN RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468081493",
"telephone_number": "260-471-3500",
"fax_number": "260-471-4263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROY",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"credential": "HSPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-04",
"last_updated": "2010-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041032A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200100610A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.