Active NPI
Connie Wordell
- Addiction (Substance Use Disorder) Counselor
- Milwaukee, WI
National Provider Identifier
1053446880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 14458
- Practice address
- 4383 N 27TH St
Milwaukee, WI 53216-1809 - Phone
- (414) 871-8883
- Fax
- (414) 871-8950
- NPI assigned
- Feb 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 14458 | WI | Primary |
Addresses
Primary practice location
4383 N 27TH St
Milwaukee, WI 53216-1809
Mailing address
N2817 State Road 57
New Holstein, WI 53061-9528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39165900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14458 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1053446880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2817 STATE ROAD 57",
"city": "NEW HOLSTEIN",
"state": "WI",
"postal_code": "530619528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4383 N 27TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532161809",
"telephone_number": "414-871-8883",
"fax_number": "414-871-8950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORDELL",
"first_name": "CONNIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "14458",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39165900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.