NPIMap

Organization Active NPI

Mind Matters Psychological Services, S.C.

  • Clinical Psychologist
  • Mequon, WI
National Provider Identifier
1891516472
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.
Practice address
1017 W Glen Oaks LN Ste 167
Mequon, WI 53092-3317
Phone
(414) 477-4264
NPI assigned
Oct 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Dr. Colleen Marie Drosdeck, PSYDNPI 1801027826
Title
Co-Owner/Psychologist
Phone
(414) 477-4264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1017 W Glen Oaks LN Ste 167
Mequon, WI 53092-3317

Mailing address

319 E Clarence St
Milwaukee, WI 53207-1503
Phone (414) 477-4264

Other identifiers 2

IdentifierTypeStateIssuer
1801027826MedicaidWI
1154550754MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241224001597 WI Part B Supplier - Clinic/Group Practice 8628505013 Receives reassigned benefits from 5 practitioners
Practice locations: Brookfield, WI; Mequon, WI

National Provider Directory

National Provider Directory

Locations

1017 W Glen Oaks Ln
Ste 167
Mequon, WI 53092
Phone (414) 502-8102

1035 W Glen Oaks Ln
Ste 110
Mequon, WI 53092
Phone (262) 240-0299

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1891516472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 E CLARENCE ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532071503",
            "telephone_number": "414-477-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 W GLEN OAKS LN STE 167",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923317",
            "telephone_number": "414-477-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "DROSDECK",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CO-OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "414-477-4264",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801027826",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154550754",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.