Individual provider Active NPI

Jenna Mohelnitzky, LCSW

  • Clinical Social Worker
  • Brown Deer, WI
National Provider Identifier
1013488022
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11069 Issued in WI
Practice address
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone
(414) 540-2170
NPI assigned
Dec 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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 18605-130 WI
Addiction (Substance Use Disorder) Counselor 101YA0400X 16597 WI
Clinical Social Worker 1041C0700X 11069 WI Primary

Addresses

Primary practice location

3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220

Mailing address

3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone (414) 540-2170

Other practice location 1

4800 S 10th St
Milwaukee, WI 53221-2412
Phone (414) 744-5370

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
I20230316000094 WI Practitioner - Clinical Social Worker 3274907183 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16597WIMDAddiction (Substance Use Disorder) Counselor
18605-130WIMDAddiction (Substance Use Disorder) Counselor
11069WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc Addiction (Substance Use Disorder) CurrentSince Mar 1, 2024 Accepting new patients

Locations

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

4811 S 76th St
Ste 208
Milwaukee, WI 53220
Phone (414) 361-1400

Networks

  • IL PPO Downstate
  • IL HMO C-SNP
  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

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.

NPI Registry JSON

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1013488022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 S 10th St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532212412",
            "country_code": "US",
            "telephone_number": "414-744-5370",
            "fax_number": "414-744-9052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHELNITZKY",
        "first_name": "JENNA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18605-130",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16597",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "11069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown Deer, WI

Sources for this page

Verify at the official NPI Registry.