Active NPI
Mandy J Kumpula, PHD
- Clinical Psychologist
- Green Bay, WI
National Provider Identifier
1639501323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301015184
- Practice address
- 2851 University Ave
Green Bay, WI 54311-5855 - Phone
- (920) 431-2938
- NPI assigned
- Aug 5, 2013
- 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 | 6301015184 | MI | Primary |
Addresses
Primary practice location
2851 University Ave
Green Bay, WI 54311-5855
Mailing address
2851 University Ave
Green Bay, WI 54311-5855
Phone (920) 431-2938
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 |
|---|---|---|---|
| 6301015184 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553558400000",
"number": "1639501323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2851 UNIVERSITY AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115855",
"telephone_number": "920-431-2938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2851 UNIVERSITY AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115855",
"telephone_number": "920-431-2938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUMPULA",
"first_name": "MANDY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-05",
"last_updated": "2019-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301015184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.