Individual provider Active NPI

Brandy Mysliwiec, PHD

  • Clinical Psychologist
  • Danville, IL
National Provider Identifier
1609493303
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20043363B Issued in IN
Practice address
1900 E Main St
Danville, IL 61832-5100
Phone
(217) 554-4872
NPI assigned
Jun 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 20043363B IN Primary

Addresses

Primary practice location

1900 E Main St
Danville, IL 61832-5100

Mailing address

6543 Stafford Trce
Zionsville, IN 46077-9176
Phone (574) 286-1573

Other names 1

  • Brandy Dinges Former name

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

LicenseStateTypeSpecialty
20043363BINMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1609493303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6543 STAFFORD TRCE",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460779176",
            "telephone_number": "574-286-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 E MAIN ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618325100",
            "telephone_number": "217-554-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYSLIWIEC",
        "first_name": "BRANDY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043363B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDY",
            "last_name": "DINGES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Danville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; 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.