Grady Emily Dedrick, LPC, SAC-IT, CCAT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8436-125 Issued in WI

Practice address

304 Bickford St
New Lisbon, WI 53950-1533

Phone

(608) 562-3976

Fax

(608) 562-3975

NPI assigned

Jun 4, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Grady Emily Keding Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Grace Counseling & Family Services S.C

  • Marriage & Family Therapist
  • New Lisbon, WI
  • NPI 1477178473
  NPD

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1124686241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 BICKFORD ST",
            "city": "NEW LISBON",
            "state": "WI",
            "postal_code": "539501533",
            "telephone_number": "608-562-3976",
            "fax_number": "608-562-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 BICKFORD ST",
            "city": "NEW LISBON",
            "state": "WI",
            "postal_code": "539501533",
            "telephone_number": "608-562-3976",
            "fax_number": "608-562-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDRICK",
        "first_name": "GRADY",
        "middle_name": "EMILY",
        "name_prefix": "Miss",
        "credential": "LPC, SAC-IT, CCAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-04",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8436-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRADY",
            "last_name": "KEDING",
            "middle_name": "EMILY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Adrienne Baumgart, RN
• Kathleen M. Berndsen, RN
• Carevan Transportation, LLC
• Anne B. Fenwick, PA
• Daniel Carl Frye, LMFT
• Abigail Geis, MS ED.
• Grace Counseling & Family Services S.C
• Glen Joseph Heinzl, MD

• Professional Counselor in New Lisbon, WI
• Providers in New Lisbon, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.