Michelle Wickizer, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY.0005676 Issued in CO

Practice address

1229 Lake Plaza Dr Ste a
Colorado Springs, CO 80906-7401

Phone

(719) 313-2578

Fax

(719) 735-4952

NPI assigned

Nov 2, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Broadmoor Psychological Services LLCGroup PAC ID 2062869266, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Broadmoor Psychological Services LLC

  • Clinical Psychologist
  • Colorado Springs, CO
  • NPI 1932989522
  Medicare reassignment Care Compare group NPD Authorized official
• Colorado Springs Psychological Services

  • Clinical Psychologist
  • Colorado Springs, CO
  • NPI 1982074969
  Medicare reassignment NPD

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1689339905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38553",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809378553",
            "telephone_number": "719-313-2578",
            "fax_number": "719-434-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 LAKE PLAZA DR STE A",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809067401",
            "telephone_number": "719-313-2578",
            "fax_number": "719-735-4952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKIZER",
        "first_name": "MICHELLE",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0005676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Whyte
• Osric Whyte
• Molly Wick
• Ashley Wickham
• Jeanne Marie Wickham, LPC, LAC
• Michelle M Wickliff
• Cindy L Wickline, MD
• Cathryn Michiko Widiger
• Pam Wiebelhaus, MS, LPC, LAC
• Cassandra Lynn Wieczerza, DDS

• Clinical Psychologist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.