Derek Jeremy John, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2306-057 Issued in WI

Practice address

631 Forest St
Wausau, WI 54403-5524

Phone

(715) 842-0944

Fax

(715) 845-6477

NPI assigned

Jul 19, 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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Center for Human Development, Inc.

  • Mental Health Counselor
  • Wausau, WI
  • NPI 1679684609
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912926601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 FOREST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035524",
            "telephone_number": "715-842-0944",
            "fax_number": "715-845-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 FOREST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035524",
            "telephone_number": "715-842-0944",
            "fax_number": "715-845-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "DEREK",
        "middle_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2306-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH INSURANCE",
            "identifier": "87249",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH NETWORK",
            "identifier": "332603",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "2187795",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Jewel, LPN
• Sulayman Jobe, RN
• Andrew Robert Johannes, D.O.
• John a Krasowski DDS LLC
• John W. Stilp, DDS, SC
• John A Johnkoski
• Kimberly A Johns, RN
• Christine M Johnsen, MS, APNP, ANP-BC
• Aaron R Johnson, DC
• Alayna Johnson, MD

• Clinical Psychologist in Wausau, WI
• Providers in Wausau, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.