Individual provider Active NPI

Kallyn Heiges, LPC

  • Professional Counselor
  • Port Washington, WI
National Provider Identifier
1205608494
Registry record updated Jan 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
12067-125 Issued in WI
Practice address
1317 W Grand Ave Ste 6
Port Washington, WI 53074-2075
Phone
(262) 427-8905
NPI assigned
Oct 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 12067-125 WI Primary
Clinical Psychologist 103TC0700X 5098-226 WI
Addiction (Substance Use Disorder) Counselor 101YA0400X WI
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X

Addresses

Primary practice location

1317 W Grand Ave Ste 6
Port Washington, WI 53074-2075

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630

Other practice location 1

2500 E Enterprise Ave Ste B
Appleton, WI 54913-8556
Phone (920) 416-8577

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
I20260211000474 WI Practitioner - Mental Health Counselor 4688153588 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Counseling Services IncGroup PAC ID 1456256023, 338 clinicians

Practice addresses (Care Compare)

1317 W Grand Ave
Suite 6
Port Washington, WI 53074-2075
Phone (262) 999-3495

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12067-125WIMDProfessional Counselor
5098-226WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc Addiction (Substance Use Disorder) CurrentSince Dec 29, 2025 Accepting new patients
Nystrom & Associates Counseling Wi., S.C. PastSince Oct 29, 2023 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

1317 W Grand Ave
Ste 6
Prt Washingtn, WI 53074
Phone (262) 284-8800

1143 Warwick Way
Racine, WI 53406
Phone (262) 321-0110

Organizations & group practices 2

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": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1205608494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVE STE 6",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530742075",
            "telephone_number": "262-427-8905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 E Enterprise Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549138556",
            "country_code": "US",
            "telephone_number": "920-416-8577",
            "fax_number": "920-416-8571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEIGES",
        "first_name": "KALLYN",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-23",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "12067-125",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "5098-226",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Washington, WI

Sources for this page

Verify at the official NPI Registry.