Active NPI
Megan E. Ilse, LPC
- Professional Counselor
- Milwaukee, WI
National Provider Identifier
1104004076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2807-125
- Practice address
- 1155 N Mayfair Rd
Department of Psychiatry
Milwaukee, WI 53226-3462 - Phone
- (414) 955-8900
- Fax
- (414) 955-6285
- NPI assigned
- Feb 4, 2008
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2807-125 | WI | Primary |
Addresses
Primary practice location
1155 N Mayfair Rd
Department of Psychiatry
Milwaukee, WI 53226-3462
Mailing address
1155 N Mayfair Rd
Department of Psychiatry
Milwaukee, WI 53226-3462
Phone (414) 955-8900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104004076 | 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 |
|---|---|---|---|
| 2807-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1104004076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 N MAYFAIR RD",
"address_2": "DEPARTMENT OF PSYCHIATRY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263462",
"telephone_number": "414-955-8900",
"fax_number": "414-955-6285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 N MAYFAIR RD",
"address_2": "DEPARTMENT OF PSYCHIATRY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263462",
"telephone_number": "414-955-8900",
"fax_number": "414-955-6285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILSE",
"first_name": "MEGAN",
"middle_name": "E.",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-04",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "2807-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104004076",
"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 Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.