Scott Devere Wylie, PSY.D., MSCP

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

2962 Issued in CO

Practice address

113 Coronado CT
Suite 202
Fort Collins, CO 80525-4911

Phone

(888) 666-0974

Fax

(970) 223-4433

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scott D Wylie, Psy.D., MSCP, LLC

  • Multi-Specialty Clinic/Center
  • Fort Collins, CO
  • NPI 1629411319
  Medicare reassignment Authorized official
• University of Wyoming

  • Federally Qualified Health Center (FQHC)
  • Laramie, WY
  • NPI 1639617061
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523059200000",
    "number": "1669497111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 CORONADO CT",
            "address_2": "STE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254911",
            "telephone_number": "888-666-0974",
            "fax_number": "970-223-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 CORONADO CT",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254911",
            "telephone_number": "888-666-0974",
            "fax_number": "970-223-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "SCOTT",
        "middle_name": "DEVERE",
        "name_prefix": "Dr.",
        "credential": "PSY.D., MSCP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2018-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WY",
            "license": "478",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18408",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "478",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "2962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI",
            "identifier": "1629411319",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128459200",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669497111",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "462318597",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah E Wright, RDH
• Richard Scott Wuerker, D.D.S.
• Elizabeth Anne Wuerslin, MD
• Janet Wulf
• Hannah Wurster, PH.D., LMFT
• Mason Lane Wyman
• Melissa Wynne-Theisen, PT, DPT
• Wyoming Physical Therapy PC
• Xermend, Inc
• Mary Jane Yahn-Hull, LPC, LAC, MA

• Clinical Neuropsychologist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Clinical Neuropsychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.