Individual provider Active NPI

Kelsey Aryne Dumanch, AU.D., CCC-A

  • Audiologist
  • Milwaukee, WI
National Provider Identifier
1265968192
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
724 Issued in WI
Practice address
9000 W Wisconsin Ave Ste B340
Milwaukee, WI 53226-4874
Phone
(414) 266-2934
Fax
(414) 266-6189
NPI assigned
May 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 9886 MN
Audiologist 231H00000X 724 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave Ste B340
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave Ste B340
Milwaukee, WI 53226-4874
Phone (414) 266-2934

Other practice location 1

345 Smith Ave N
Saint Paul, MN 55102-2346
Phone (952) 992-5691

Other identifiers 1

IdentifierTypeStateIssuer
1265968192MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170616000234 MN Practitioner - Qualified Audiologist 7315215340 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
724WIMDAddiction (Substance Use Disorder) Counselor
9886MNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Health Care CurrentSince Nov 18, 2024 Accepting new patients
Childrens Health Care Current Accepting new patients
Childrens Health Care CurrentSince Nov 18, 2024 Accepting new patients
Childrens Health Care Past Accepting new patients
Childrens Hospital of Wisconsin, Inc. PastSince Nov 8, 2020 Accepting new patients

Locations

2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691

347 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-6000

345 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-6000

Organizations & group practices 5

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": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1265968192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE STE B340",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2934",
            "fax_number": "414-266-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE STE B340",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2934",
            "fax_number": "414-266-6189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Smith Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022346",
            "country_code": "US",
            "telephone_number": "952-992-5691",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUMANCH",
        "first_name": "KELSEY",
        "middle_name": "ARYNE",
        "credential": "AU.D., CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "9886",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265968192",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.