Kimberly Brandhagen, APSW, SAC-IT
Individual provider Active NPI Social Worker · Elm Grove, WI
NPI 1265092167 · NPPES record last updated Apr 27, 2021
Key facts
- NPI
- 1265092167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 131282-121 (WI)
- Practice address
- 12970 W Bluemound Rd Ste 200
Elm Grove, WI 53122-2607 - Phone
- (262) 780-1020
- NPI assigned
- Jun 13, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 10, 2024 through Sep 10, 2026
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 131282-121 | WI | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 131282-121 | WI | Yes |
Addresses
Primary practice location
12970 W Bluemound Rd Ste 200
Elm Grove, WI 53122-2607
Mailing address
12970 W Bluemound Rd Ste 200
Elm Grove, WI 53122-2607
Phone (262) 780-1020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265092167 | Medicaid | WI |
Other providers in Elm Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2021. 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.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.