Individual provider Active NPI

Kaylee T Ninnemann, LPC

  • Professional Counselor
  • Luxemburg, WI
National Provider Identifier
1184075434
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6777-125 Issued in WI
Practice address
140 School Creek TRL
Luxemburg, WI 54217-1095
Phone
(920) 845-1370
Fax
(920) 845-1379
NPI assigned
Jun 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6777-125 WI Primary

Addresses

Primary practice location

140 School Creek TRL
Luxemburg, WI 54217-1095

Mailing address

PO Box 22040
Green Bay, WI 54305-2040
Phone (920) 445-7222

Other practice location 1

3415 Custer St Ste D
Manitowoc, WI 54220-4328
Phone (920) 652-9310

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
I20240103001064 WI Practitioner - Mental Health Counselor 7012367055 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

301 E Saint Joseph St
Green Bay, WI 54301-2241
Phone (920) 433-3630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Psychiatric Center Inc Current Accepting new patients
Bellin Memorial Hospital Inc Professional CurrentSince Apr 14, 2025 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Apr 14, 2025 Accepting new patients
Bellin Psychiatric Center Inc CurrentSince Jan 2, 2024 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Psychiatric Center Inc. Mental Health CurrentSince Jan 2, 2024 Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

301 Saint Joseph St
Green Bay, WI 54301
Phone (920) 430-3630

140 School Creek Trl
Luxemburg, WI 54217
Phone (920) 845-1370

140 School Creek Trl
#B
Luxemburg, WI 54217
Phone (920) 845-1370

3415 Custer St
Ste D
Manitowoc, WI 54220
Phone (920) 652-9310

Organizations & group practices 6

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1184075434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22040",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052040",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SCHOOL CREEK TRL",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171095",
            "telephone_number": "920-845-1370",
            "fax_number": "920-845-1379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3415 Custer St Ste D",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542204328",
            "country_code": "US",
            "telephone_number": "920-652-9310",
            "fax_number": "920-652-9316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NINNEMANN",
        "first_name": "KAYLEE",
        "middle_name": "T",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6777-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Luxemburg, WI

Sources for this page

Verify at the official NPI Registry.