Marc J Ackerman, PHD – Psychologist in Glendale, WI

Key facts

NPI: 1972687358
Entity type: Individual (NPI type 1)
Primary specialty: Psychologist 103T00000X
License: 506057 (WI)
Practice address: 5800 N Bayshore Drive
A 250
Glendale, WI 53217-4536
Phone: (414) 962-6764
Fax: (414) 962-6765
NPI assigned: Oct 24, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Achievement Associates, LTD Clinical Psychologist · Mequon, WI · NPI 1154365971

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
506057	WI	MD	Psychologist

Practice roles

Organization	Specialty	Status	New patients
Achievement Associates, LTD		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	506057	WI	Yes

Addresses

Primary practice location

5800 N Bayshore Drive
A 250
Glendale, WI 53217-4536

Mailing address

5800 N Bayshore Drive
A 250
Glendale, WI 53217-4536
Phone (414) 962-6764

Other identifiers

Identifier	Type	State	Issuer
39052800	Medicaid	WI

Other providers in Glendale, WI

All providers in Glendale, WI · Psychologist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.