Active NPI
Robert Roy Segerstrom, EDD
- Clinical Psychologist
- Sterling, CO
National Provider Identifier
1669510467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1413
- Practice address
- 224 S Second Street
Sterling, CO 80751 - Phone
- (970) 522-6736
- Fax
- (970) 521-7151
- NPI assigned
- Feb 2, 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 | 1413 | CO | Primary |
Addresses
Primary practice location
224 S Second Street
Sterling, CO 80751
Mailing address
224 S Second Street
Sterling, CO 80751
Phone (970) 522-6736
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 |
|---|---|---|---|
| 1413 | CO | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669510467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 S SECOND STREET",
"city": "STERLING",
"state": "CO",
"postal_code": "80751",
"telephone_number": "970-522-6736",
"fax_number": "970-521-7151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 S SECOND STREET",
"city": "STERLING",
"state": "CO",
"postal_code": "80751",
"telephone_number": "970-522-6736",
"fax_number": "970-521-7151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEGERSTROM",
"first_name": "ROBERT",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "1413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling, CO
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.