Individual provider Active NPI

Thomas John Zakrzewski, LCSW

  • Clinical Social Worker
  • Manitowoc, WI
National Provider Identifier
1194874511
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7452 Issued in WI
Practice address
Manitowoc County Human Services Department
926 S 8TH Street
Manitowoc, WI 54221-1177
Phone
(920) 683-4230
Fax
(920) 720-3806
NPI assigned
Jan 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.011635 IL
Clinical Social Worker 1041C0700X 7452 WI Primary

Addresses

Primary practice location

Manitowoc County Human Services Department
926 S 8TH Street
Manitowoc, WI 54221-1177

Mailing address

Manitowoc County Human Services Department
926 S 8TH Street
Manitowoc, WI 54221-1177
Phone (920) 683-4230

Other identifiers 1

IdentifierTypeStateIssuer
04932561OtherILBCBS PPO

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.011635ILMDClinical Social Worker
7452WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
GJB Eeg Services, SC CurrentSince Jul 4, 2021 Accepting new patients
Family Services of Northeast Wisconsin Inc Past Accepting new patients
Family Services of Northeast Wisconsin Inc Past Accepting new patients

Locations

711 N Lynndale Dr
Ste 1A
Appleton, WI 54914
Phone (920) 217-7861

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1194874511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT",
            "address_2": "926 S 8TH STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542211177",
            "telephone_number": "920-683-4230",
            "fax_number": "920-720-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT",
            "address_2": "926 S 8TH STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542211177",
            "telephone_number": "920-683-4230",
            "fax_number": "920-720-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAKRZEWSKI",
        "first_name": "THOMAS",
        "middle_name": "JOHN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.011635",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PPO",
            "identifier": "04932561",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.