Wayne D Samuelson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

75 Issued in ND

Practice address

1351 Page Dr S Ste 105
Fargo, ND 58103-3536

Phone

(701) 893-3419

NPI assigned

Jan 23, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Carita R Shawchuck PHD PC

  • Clinical Child & Adolescent Psychologist
  • Fargo, ND
  • NPI 1871650267
  NPD (past)
• Knowlton, O'Neill & Associates, P.C.

  • Psychologist
  • West Fargo, ND
  • NPI 1538198759
  NPD (past)
• Family Based Therapy Associates

  • Mental Health Counselor
  • Coon Rapids, MN
  • NPI 1194762005
  NPD (past)
• Family Based Therapy Associates

  • Community/Behavioral Health Agency
  • Chisago City, MN
  • NPI 1891100293
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1821068966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-893-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-893-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "WAYNE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "75",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Marie Samson, PHD
• Tessa Samson
• Walter Vincent Samuel, D.D.S.
• Lisa Andrea Samuelson, OTR
• Paige Rae Samuelson, PT, DPT
• Mohamed Sanaullah, MD
• Cyd Sanchez
• Sanctuary Massage Therapy Inc.
• Kenna Jo Sand, DO
• Nicole Carol Sand, LPC

• Clinical Psychologist in Fargo, ND
• Providers in Fargo, ND by specialty
• Clinical Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.

Verify at the official NPI Registry.