Individual provider Active NPI

Roger Patrick Northway, MS LCSW

  • Professional Counselor
  • Brookfield, WI
National Provider Identifier
1053449173
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
477125 Issued in WI
Practice address
13105 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8046
Phone
(262) 641-9790
Fax
(262) 641-9791
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 477125 WI Primary
Clinical Social Worker 1041C0700X 2661123 WI

Addresses

Primary practice location

13105 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8046

Mailing address

13105 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8046
Phone (262) 641-9790

Other identifiers 1

IdentifierTypeStateIssuer
39197200MedicaidWI

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
I20220531002418 WI Practitioner - Clinical Social Worker 8729011374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathways Counseling Center II LLCGroup PAC ID 7315970969, 9 clinicians

Practice addresses (Care Compare)

11121 W Oklahoma Ave
West Allis, WI 53227-4033
Phone (262) 641-9790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
477125WIMDProfessional Counselor
2661123WIMDClinical Social Worker
2661WIMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Counseling Center II LLC CurrentSince May 19, 2022 Accepting new patients
Allergic Diseases SC PastSince May 19, 2022 Accepting new patients

Locations

13105 W Bluemound Rd
Ste 100
Brookfield, WI 53005
Phone (262) 641-9790

11121 W Oklahoma Ave
West Allis, WI 53227
Phone (262) 641-9790

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": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1053449173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13105 W BLUEMOUND RD",
            "address_2": "SUITE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530058046",
            "telephone_number": "262-641-9790",
            "fax_number": "262-641-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13105 W BLUEMOUND RD",
            "address_2": "SUITE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530058046",
            "telephone_number": "262-641-9790",
            "fax_number": "262-641-9791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORTHWAY",
        "first_name": "ROGER",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "MS LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "477125",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2661123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39197200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.