Coleen Rae Kittleson, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1407-125 Issued in WI

Practice address

12970 W Bluemound Rd
308
Elm Grove, WI 53122-2607

Phone

(262) 780-1020

Fax

(262) 780-1022

NPI assigned

Jan 9, 2009

Last updated

Feb 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Collaborative Counseling LLC

  • Mental Health Counselor
  • Maple Grove, MN
  • NPI 1598034324
  Medicare reassignment NPD
• Red Oak Counseling, LTD.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elm Grove, WI
  • NPI 1609890391
  NPD (past)

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1073750295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12970 W BLUEMOUND RD STE 200",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222607",
            "telephone_number": "262-780-1020",
            "fax_number": "262-780-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12970 W BLUEMOUND RD",
            "address_2": "308",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222607",
            "telephone_number": "262-780-1020",
            "fax_number": "262-780-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITTLESON",
        "first_name": "COLEEN",
        "middle_name": "RAE",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-09",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "1407-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10001649",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kindo Integrated Health Center LLC
• Susan L King, RPH
• Marilynn Klemstein, NP
• Michaela R Klimko, LPC
• Ariel Namowicz Kloss, LCSW
• Koch Chiropractic LTD.
• Dennis A Koch, D.C.

• Professional Counselor in Elm Grove, WI
• Providers in Elm Grove, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.