Active NPI
Kathleen Claire Glick, LPC, NCC
- Professional Counselor
- Neenah, WI
National Provider Identifier
1285032565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6133-125
- Practice address
- 40 Jewelers Park Dr Ste 200
Neenah, WI 54956-3893 - Phone
- (920) 521-7133
- Fax
- (920) 521-7134
- NPI assigned
- Dec 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6133-125 | WI | Primary |
Addresses
Primary practice location
40 Jewelers Park Dr Ste 200
Neenah, WI 54956-3893
Mailing address
40 Jewelers Park Dr Ste 200
Neenah, WI 54956-3893
Phone (920) 521-7133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 13, 2024 through Jul 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6133-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570579200000",
"number": "1285032565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 JEWELERS PARK DR STE 200",
"city": "NEENAH",
"state": "WI",
"postal_code": "549563893",
"telephone_number": "920-521-7133",
"fax_number": "920-521-7134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 JEWELERS PARK DR STE 200",
"city": "NEENAH",
"state": "WI",
"postal_code": "549563893",
"telephone_number": "920-521-7133",
"fax_number": "920-521-7134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICK",
"first_name": "KATHLEEN",
"middle_name": "CLAIRE",
"credential": "LPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-18",
"last_updated": "2019-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "6133-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Neenah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.