Individual provider Active NPI

Marshall L Kirkpatrick

  • Professional Counselor
  • Reedsville, WI
National Provider Identifier
1174793236
Registry record updated Sep 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6170-125 Issued in WI
Practice address
PO Box 218
Reedsville, WI 54230-0218
Phone
(920) 840-2745
NPI assigned
Mar 5, 2008
Last updated
Sep 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6170-125 WI Primary
Clinical Social Worker 1041C0700X LH00011185 WA

Addresses

Primary practice location

PO Box 218
Reedsville, WI 54230-0218

Mailing address

109 N Ruby St
Ellensburg, WA 98926-3382
Phone (509) 933-1354

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20250721002411 WI Practitioner - Mental Health Counselor 4486160033 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LH00011185WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kirkpatrick & Associates, LLC Professional CurrentSince Nov 10, 2024 Accepting new patients
Summit Clinical Services LLC Clinical CurrentSince May 28, 2025 Accepting new patients

Locations

816 Washington St
Manitowoc, WI 54220
Phone (262) 719-5177

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727481600000",
    "number": "1174793236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N RUBY ST",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263382",
            "telephone_number": "509-933-1354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "REEDSVILLE",
            "state": "WI",
            "postal_code": "542300218",
            "telephone_number": "920-840-2745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKPATRICK",
        "first_name": "MARSHALL",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-05",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6170-125",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LH00011185",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reedsville, WI

Sources for this page

Verify at the official NPI Registry.