Active NPI
Bradley D. Woldt, PH.D.
- Clinical Psychologist
- Brookings, SD
National Provider Identifier
1699982371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 357
- Practice address
- 928 4TH St
Suite 6
Brookings, SD 57006-2171 - Phone
- (605) 692-6011
- Fax
- (605) 692-6011
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 357 | SD | Primary |
Addresses
Primary practice location
928 4TH St
Suite 6
Brookings, SD 57006-2171
Mailing address
PO Box 8563
Brookings, SD 57006-8563
Phone (605) 692-6011
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 |
|---|---|---|---|
| 357 | SD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699982371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8563",
"city": "BROOKINGS",
"state": "SD",
"postal_code": "570068563",
"telephone_number": "605-692-6011",
"fax_number": "605-692-6011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 4TH ST",
"address_2": "SUITE 6",
"city": "BROOKINGS",
"state": "SD",
"postal_code": "570062171",
"telephone_number": "605-692-6011",
"fax_number": "605-692-6011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLDT",
"first_name": "BRADLEY",
"middle_name": "D.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SD",
"license": "357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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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.