Active NPI
Catherine Gray
- Addiction (Substance Use Disorder) Counselor
- Menasha, WI
National Provider Identifier
1285050294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 15847-130
- Practice address
- 1478 Kenwood Dr Ste D1
Menasha, WI 54952-1161 - Phone
- (920) 722-0311
- Fax
- (920) 722-0313
- NPI assigned
- Mar 14, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15847-130 | WI | Primary |
Addresses
Primary practice location
1478 Kenwood Dr Ste D1
Menasha, WI 54952-1161
Mailing address
1478 Kenwood Dr Ste D1
Menasha, WI 54952-1161
Phone (920) 722-0311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15847-130 | Other | WI | WISCONSIN DHS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15847-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395100800000",
"number": "1285050294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1478 KENWOOD DR STE D1",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521161",
"telephone_number": "920-722-0311",
"fax_number": "920-722-0313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1478 KENWOOD DR STE D1",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521161",
"telephone_number": "920-722-0311",
"fax_number": "920-722-0313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CATHERINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-14",
"last_updated": "2014-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "15847-130",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WISCONSIN DHS",
"identifier": "15847-130",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.