Pediatric Psychological Services PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301009191 Issued in MI

Legal business name

PEDIATRIC PSYCHOLOGICAL SERVICES PLLC

Practice address

714 Main St
Battle Creek, MI 49015-4568

Phone

(269) 979-3881

Fax

(269) 979-2841

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Kay Wisdorf-Houtkooper, PH.D.NPI 1073610796

Title

Licensed Psychologist

Phone

(269) 979-3881

Specialties & licenses 1

Addresses

Tax ID family

Pediatric Psychological Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Psychological Services

  • Clinical Psychologist
  • Hastings, MI
  • NPI 1780733881
  NPD tax ID

Practitioners 1

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

• Kimberly Kay Wisdorf-Houtkooper, PH.D.

  • Clinical Psychologist
  • Battle Creek, MI
  • NPI 1073610796
  NPD (past) Authorized official

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952450108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5181 WALNUT RDG",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490179210",
            "telephone_number": "269-979-3881",
            "fax_number": "269-979-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 MAIN ST",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490154568",
            "telephone_number": "269-979-3881",
            "fax_number": "269-979-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WISDORF-HOUTKOOPER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "269-979-3881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301009191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary C. Peacock, MSW, LMSW, ACSW
• Kailyn Peak
• Melani Kanani Pearce
• Pearle Vision Inc (Pearle Vision #C6820)
• Kimberly Peck
• Debra Pemberton, LLMSW
• Amelia R Penamon, LMSW
• Steve Henry Pendziszewski, PSY.D.
• Andrea Penick, LMSW
• Kristy Penick, P.T.

• Clinical Psychologist in Battle Creek, MI
• Providers in Battle Creek, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.