Nicole M Kaiser, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9685-123 Issued in WI

Practice address

1160 Lincoln Ave
Fennimore, WI 53809-1746

Phone

(608) 822-5052

Fax

(608) 776-4914

NPI assigned

Sep 27, 2013

Last updated

Jan 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Nicole M Bastis Former name

Medicare fee-for-service enrollment

Enrolled in WI, IA2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

• GTN Fennimore, Inc.

  dba Southwest Counseling

  • Clinical Social Worker
  • Fennimore, WI
  • NPI 1306251640
  Medicare reassignment NPD
• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700

  WI

  Medicare reassignment NPD
• Midwest Counseling Associates, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dubuque, IA
  • NPI 1427848886
  Medicare reassignment

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1184051807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 LINCOLN AVE",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "538091746",
            "telephone_number": "608-822-5052",
            "fax_number": "608-776-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 LINCOLN AVE",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "538091746",
            "telephone_number": "608-822-5052",
            "fax_number": "608-776-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAISER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-27",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9685-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80727",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BASTIS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• GTN Fennimore, Inc. (Southwest Counseling)
• Jacqueline Hanson, RPH
• Hartig Drug Co Corp
• Amanda Lee Haugrud, PTA
• High Point Family Medicine, LLC
• Lori Lynn Kartman
• Kaitlin Kersten, OTD, EMT-P
• Rita M. Lease, PMHNP-BC
• Zhenyu Liang, D.D.S.
• Richard Merwin Lofthouse Sr., D.D.S.

• Clinical Social Worker in Fennimore, WI
• Providers in Fennimore, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.