Active NPI
Sandra D Bouman, LCSW
- Social Worker
- Waukesha, WI
National Provider Identifier
1164510954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 1962123
- Practice address
- 414 W Moreland Blvd
Suite #205 Family Service of Waukesha
Waukesha, WI 53188 - Phone
- (262) 547-5567
- Fax
- (262) 547-1608
- NPI assigned
- Oct 10, 2006
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 1962123 | WI | Primary |
Addresses
Primary practice location
414 W Moreland Blvd
Suite #205 Family Service of Waukesha
Waukesha, WI 53188
Mailing address
414 W Moreland Blvd
Suite #205 Family Service of Waukesha
Waukesha, WI 53188
Phone (262) 547-5567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39509400 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1962123 | WI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Service Agency of Waukesha County Inc | Past | Accepting new patients | |
| Family Services of Waukesha | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukesha, WI
- NPI 1568404671
-
- Community/Behavioral Health Agency
- Waukesha, WI
- NPI 1265677884
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164510954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 W MORELAND BLVD",
"address_2": "SUITE #205 FAMILY SERVICE OF WAUKESHA",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "53188",
"telephone_number": "262-547-5567",
"fax_number": "262-547-1608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 W MORELAND BLVD",
"address_2": "SUITE #205 FAMILY SERVICE OF WAUKESHA",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "53188",
"telephone_number": "262-547-5567",
"fax_number": "262-547-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUMAN",
"first_name": "SANDRA",
"middle_name": "D",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "1962123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39509400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.