Joseph S Maciejko, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

00085 Issued in IA

Practice address

4455 E 56TH St
Davenport, IA 52807-2995

Phone

(563) 355-2577

Fax

(563) 355-4015

NPI assigned

Oct 6, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1922096791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 LINCOLN RD",
            "address_2": "STE L10",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224190",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "563-355-2577",
            "fax_number": "563-355-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACIEJKO",
        "first_name": "JOSEPH",
        "middle_name": "S",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "00085",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "00240",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK HEALTH PLAN",
            "identifier": "42652",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083568",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH PLAN",
            "identifier": "IA0195",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Davenport, IA
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• Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.