Trevor Konetzke, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

19489-130 Issued in WI

Practice address

201 S Glenridge CT
Appleton, WI 54914-3905

Phone

(920) 731-3981

NPI assigned

Feb 8, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Apricity Outpatient & Peer Support Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Appleton, WI
  • NPI 1427984731
  NPD (past)
• Mooring Programs, Inc

  • Substance Abuse Rehabilitation Facility
  • Appleton, WI
  • NPI 1760709299
  NPD (past)

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1013661131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S GLENRIDGE CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S GLENRIDGE CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143905",
            "telephone_number": "920-731-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONETZKE",
        "first_name": "TREVOR",
        "credential": "SAC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19489-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Auburn Kohlman, PHARMD
• Obrad S Kokanovic, M.D
• Sara Anne Kokko, MS CCC-SLP
• Timothy James Koll, D.D.S.
• Celine A Konetzke, SAC-IT
• Elizabeth A Konkel
• Susan Deborah Konkle, PTA
• Kenneth E Konopka, DDS
• Kayla Kons, LMT
• Karen R Konz, DO

• Addiction (Substance Use Disorder) Counselor in Appleton, WI
• Providers in Appleton, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.