Samantha Nicole Wiegand, ED.S., M.S.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

2379352 Issued in IL

Practice address

707 N Smiley St
O Fallon, IL 62269-1353

Phone

(618) 632-6391

NPI assigned

Aug 24, 2022

Sex

Female

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)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1841919701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4826 RED OAK DR",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622983068",
            "telephone_number": "618-540-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N SMILEY ST",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691353",
            "telephone_number": "618-632-6391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Ogle Rd",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622697120",
            "country_code": "US",
            "telephone_number": "618-632-8406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEGAND",
        "first_name": "SAMANTHA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "ED.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IL",
            "license": "2379352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Psychologist in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• School Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.