DR. JEANNE MARIE HERZOG PHD
NPI 1124173133
Psychologist in Elm Grove, WI

Active since January 23, 2007Opted out of Medicare · through May 1, 2027
890 ELM GROVE RD STE 214, ELM GROVE, WI 53122(414) 258-8488(262) 547-1978 Get Directions Write a Review

NPPES record last updated: March 15, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jeanne Marie Herzog Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JEANNE MARIE HERZOG PHD (NPI 1124173133) is an individual psychologist in Elm Grove, Wisconsin, licensed in Wisconsin (2176057) and active in the NPI registry since January 2007. She has opted out of Medicare through May 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1124173133
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. JEANNE MARIE HERZOGCredential: PHD
Location Address890 ELM GROVE RD STE 214Elm Grove, WI 53122-2528
Mailing Address2912 Devonshire CtWaukesha, WI 53188-1368 · (414) 258-8488 · Fax (262) 547-1978
Fax(262) 547-1978
Sole ProprietorYes
Enumeration DateJanuary 23, 2007
Last NPPES UpdateMarch 15, 2023
NPPES CertifiedMarch 15, 2023
NPI 1124173133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in WI · 2176057
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 2176-57 (WI)
890 ELM GROVE RD STE 214, Elm Grove, WI 53122

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Jeanne Marie Herzog Phd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 1, 2013 through May 1, 2027.

Opt-Out Effective DateMay 1, 2013
Opt-Out In Effect ThroughMay 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeanne Herzog's NPI number?

The NPI number for Jeanne Herzog is 1124173133. It was assigned to this individual provider in the NPPES registry on January 23, 2007.

Where is Jeanne Herzog located?

Jeanne Herzog practices at 890 Elm Grove Rd Ste 214, Elm Grove, WI 53122. The listed phone number is (414) 258-8488.

What is Jeanne Herzog's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Jeanne Herzog enrolled in Medicare?

No. Jeanne Herzog has opted out of Medicare through May 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jeanne Herzog was last updated on March 15, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.