Individual provider Active NPI

Samikqua Spencer, LCSW

  • Clinical Social Worker
  • West Allis, WI
National Provider Identifier
1013478312
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
12001 Issued in WI
Practice address
1751 S 115TH CT Apt 101
West Allis, WI 53214-3779
Phone
(414) 573-4584
NPI assigned
Mar 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 18477 WI
Social Worker 104100000X 132328-121 WI
Clinical Social Worker 1041C0700X 12001 WI Primary

Addresses

Primary practice location

1751 S 115TH CT Apt 101
West Allis, WI 53214-3779

Mailing address

1751 S 115TH CT Apt 101
West Allis, WI 53214-3779
Phone (414) 573-4584

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250113002288 WI Practitioner - Clinical Social Worker 4688102049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

13900 W National Ave
New Berlin, WI 53151-9515
Phone (262) 928-4500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18477WIMDAddiction (Substance Use Disorder) Counselor
132328-121WIMDSocial Worker
12001WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc CurrentSince Jan 1, 2025 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Jan 1, 2025 Accepting new patients

Locations

13900 W National Ave
New Berlin, WI 53151
Phone (262) 928-4500

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

721 American Ave
Ste 501
Waukesha, WI 53188
Phone (262) 928-2396

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1013478312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 S 115TH CT APT 101",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143779",
            "telephone_number": "414-573-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 S 115TH CT APT 101",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143779",
            "telephone_number": "414-573-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "SAMIKQUA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18477",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "132328-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "12001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.