Active NPI
Brenda J. Ingram-Wallace, PH.D.
- Clinical Psychologist
- Reading, PA
National Provider Identifier
1750582946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS006970L
- Practice address
- 1401 Union Street
Reading, PA 19604 - Phone
- (610) 921-7585
- Fax
- (610) 929-6697
- NPI assigned
- May 29, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | PS006970L | PA | Primary |
Addresses
Primary practice location
1401 Union Street
Reading, PA 19604
Mailing address
PO Box 13736
Reading, PA 19612-3736
Phone (610) 921-7585
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 |
|---|---|---|---|
| PS006970L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750582946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13736",
"city": "READING",
"state": "PA",
"postal_code": "196123736",
"telephone_number": "610-921-7585",
"fax_number": "610-929-6697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 UNION STREET",
"city": "READING",
"state": "PA",
"postal_code": "19604",
"telephone_number": "610-921-7585",
"fax_number": "610-929-6697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM-WALLACE",
"first_name": "BRENDA",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS006970L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reading, PA
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.