Tracy Wutzke, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY17239 Issued in CA

Practice address

9888 Carroll Centre Rd Ste 216
San Diego, CA 92126-4515

Phone

(858) 413-7557

NPI assigned

Apr 13, 2007

Last updated

Nov 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 23, 2024 through Jan 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tracy Wutzke, Psy.D

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1750827499
  NPD Authorized official

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1841415122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9888 CARROLL CENTRE RD STE 216",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264515",
            "telephone_number": "858-413-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 CARROLL CENTRE RD STE 216",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264515",
            "telephone_number": "858-413-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUTZKE",
        "first_name": "TRACY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY17239",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17239",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Patrice Wunsch
• Lindsay Wunsch, LAC
• Monica Wurster
• Jadabel Wuterich
• David E. Wutke, MD
• WW NP Nursing Inc (Lux Telemedicine and Concierge)
• Kara Wyant-Cruz
• Alexandra Wyatt
• Dawn Kay Wyatt
• Jennifer Wyatt

• Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.