Dominique Balderas, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11434125 Issued in WI

Practice address

W317S3439 State Road 83 Apt B
Waukesha, WI 53189-9428

Phone

(414) 759-5247

NPI assigned

Feb 10, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1245984996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W317S3439 STATE ROAD 83 APT B",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531899428",
            "telephone_number": "414-759-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W317S3439 STATE ROAD 83 APT B",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531899428",
            "telephone_number": "414-759-5247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDERAS",
        "first_name": "DOMINIQUE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-10",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19426",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "11434125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Glen Bakalars, M.D.
• Jessica Anne Baker, PSYD, LPC
• Lisa A Baker
• Richard Norman Baker, CSW LPC
• Meaghan Elizabeth Bakkum, LCSW
• Nicole Ashley Balistreri, MS, OTR/L
• Linda Ball-Dicus
• Kathleen Ball, LCSW
• Meghan Ballard
• Isabella Jasmine Balma

• Mental Health Counselor in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.