Active NPI
Kenneth H Waldron, PH. D.
- Clinical Psychologist
- Middleton, WI
National Provider Identifier
1598870834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1774054
- Practice address
- 6702 Stonefield Road
Middleton, WI 53562 - Phone
- (608) 836-5529
- Fax
- (608) 836-8059
- NPI assigned
- Aug 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 | 1774054 | WI | Primary |
Addresses
Primary practice location
6702 Stonefield Road
Middleton, WI 53562
Mailing address
2765 Evergreen Drive
Cambridge, WI 53523
Phone (608) 423-3707
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39104500 | Medicaid | WI |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1774054 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598870834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2765 EVERGREEN DRIVE",
"city": "CAMBRIDGE",
"state": "WI",
"postal_code": "53523",
"telephone_number": "608-423-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6702 STONEFIELD ROAD",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "53562",
"telephone_number": "608-836-5529",
"fax_number": "608-836-8059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDRON",
"first_name": "KENNETH",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1774054",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39104500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middleton, WI
Sources for this page
- 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.