Active NPI
Joseph F Roe, PSY D
- Clinical Psychologist
- Medford, WI
National Provider Identifier
1750550687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1375-057
- Practice address
- 136 W Broadway Ave
Medford, WI 54451-1757 - Phone
- (715) 748-4535
- Fax
- (715) 748-0627
- NPI assigned
- Feb 25, 2008
- 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 | 1375-057 | WI | Primary |
Addresses
Primary practice location
136 W Broadway Ave
Medford, WI 54451-1757
Mailing address
PO Box 297
Medford, WI 54451-0297
Phone (715) 748-4535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39231800 | Medicaid | WI |
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 |
|---|---|---|---|
| 1375-057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1750550687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 297",
"city": "MEDFORD",
"state": "WI",
"postal_code": "544510297",
"telephone_number": "715-748-4535",
"fax_number": "715-748-0627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 W BROADWAY AVE",
"city": "MEDFORD",
"state": "WI",
"postal_code": "544511757",
"telephone_number": "715-748-4535",
"fax_number": "715-748-0627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROE",
"first_name": "JOSEPH",
"middle_name": "F",
"credential": "PSY D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1375-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39231800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.