Pediatric Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301009191 Issued in MI

Legal business name

PEDIATRIC PSYCHOLOGICAL SERVICES

Practice address

202 S Broadway St
Suite 3
Hastings, MI 49058-1886

Phone

(269) 979-3881

Fax

(269) 979-2841

NPI assigned

Jan 9, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Kay Wisdorf-Houtkooper, PH.D.NPI 1073610796

Title

Licensed Psychologist

Phone

(269) 979-3881

Specialties & licenses 1

Addresses

Tax ID family

Pediatric Psychological Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Psychological Services PLLC

  • Clinical Psychologist
  • Battle Creek, MI
  • NPI 1952450108
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Kay Wisdorf-Houtkooper, PH.D.

  • Clinical Psychologist
  • Battle Creek, MI
  • NPI 1073610796
  NPD (past) Authorized official

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780733881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5181 WALNUT RDG",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490179210",
            "telephone_number": "269-979-3881",
            "fax_number": "269-979-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S BROADWAY ST",
            "address_2": "SUITE 3",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581886",
            "telephone_number": "269-979-3881",
            "fax_number": "269-979-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WISDORF-HOUTKOOPER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "269-979-3881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301009191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylee June Page, RN
• David B Parker, MD
• Andrew M Parsons, M.D.
• Fergus Munro Peacock, M.D.
• Meghan Pearson, MA TLLP, RAC
• Whitney Pennington
• Pennock Hospital (Spectrum Health Pennock)
• Pennock Hospital
• Pennock Hospital
• Pennock Hospital (Corewell Health Pennock Hospital)

• Clinical Psychologist in Hastings, MI
• Providers in Hastings, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.