Active NPI
Samantha Nelson
- Addiction (Substance Use Disorder) Counselor
- Sheboygan, WI
National Provider Identifier
1194177832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 16682-130
- Practice address
- 2842 S Business Dr
Sheboygan, WI 53081-6518 - Phone
- (920) 458-6527
- NPI assigned
- Jul 6, 2016
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16682-130 | WI | Primary |
Addresses
Primary practice location
2842 S Business Dr
Sheboygan, WI 53081-6518
Mailing address
1310 22ND St
Two Rivers, WI 54241-2649
Phone (920) 629-7043
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100013852 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16682-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467763200000",
"number": "1194177832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 22ND ST",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "542412649",
"telephone_number": "920-629-7043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2842 S BUSINESS DR",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530816518",
"telephone_number": "920-458-6527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-06",
"last_updated": "2016-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "16682-130",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100013852",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheboygan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.