Theresa Ketchum-Fish
Individual provider Active NPI Professional Counselor · Ashland, WI
NPI 1194126433 · NPPES record last updated Mar 1, 2017
Key facts
- NPI
- 1194126433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6395-125 (WI)
- Practice address
- 300 Main St W
Ashland, WI 54806-1639 - Phone
- (715) 685-2200
- NPI assigned
- Sep 5, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bad River Band of Lake Superior Tribe of Chippewa Indians Wis
Practice addresses (Care Compare)
53585 Nokomis Rd
Ashland, WI 54806-4272
Phone (715) 682-7133
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240420000168 | TX | Practitioner - Mental Health Counselor | 9032558218 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6395-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bad River Band of Lake Superior Tribe of Chippewa Indians Wis. | Current |
Accepting new patients | |
| Bad River Band of Lake Superior Tribe of Chippewa Indians Wis | Current | Accepting new patients | |
| Bad River Band of Lake Superior Tribe of Chippewa Indains Wis | Current |
Accepting new patients |
Locations
53585 Nokomis Rd
Ashland, WI 54806
Phone (715) 682-7133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6395-125 | WI | Yes |
Addresses
Primary practice location
300 Main St W
Ashland, WI 54806-1639
Mailing address
7665 US Highway 2
Iron River, WI 54847-4690
Phone (715) 685-2200
Other providers in Ashland, WI
- Steven Stranberg Kassof
- Dana R Katchka
- Jessica Kelm
- Robin Kemkes
- Kenneth N Krutsch MDSC
- Karen Keyes
- Kristi Jean Kiel
- Grace M Kilbane
- Lisa Ogimaakwe Kingfisher
- Carole Kjellander
All providers in Ashland, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.