NPIMap

Organization Active NPI

Advance Clinical Services

Doing business as Advance Clinical Services LLC

  • Clinical Social Worker
  • Kenosha, WI
National Provider Identifier
1124791595
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
ADVANCE CLINICAL SERVICES
Doing business as
Advance Clinical Services LLC
Practice address
6121 Green Bay Rd Ste 200
Kenosha, WI 53142-2931
Phone
(262) 694-3718
NPI assigned
Jul 30, 2021
Last updated
Aug 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

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

Authorized official

Name
Nicholas Olsen, LCSWNPI 1104223510
Title
Owner
Phone
(262) 694-3718

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

6121 Green Bay Rd Ste 200
Kenosha, WI 53142-2931

Mailing address

6121 Green Bay Rd Ste 200
Kenosha, WI 53142-2931
Phone (262) 694-3718

Other names 1

  • Advance Clinical Services LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250905000440 WI Part B Supplier - Clinic/Group Practice 4486156874 Receives reassigned benefits from 6 practitioners
Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory

Locations

6121 Green Bay Rd
Ste 200
Kenosha, WI 53142
Phone (262) 694-3718

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1124791595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6121 GREEN BAY RD STE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422931",
            "telephone_number": "262-694-3718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 GREEN BAY RD STE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422931",
            "telephone_number": "262-694-3718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE CLINICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-30",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-694-3718",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advance Clinical Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.