NPIMap

Organization Active NPI

Virago Wellness Initiative, LLC

  • Clinical Psychologist
  • Appleton, WI
National Provider Identifier
1285412411
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
VIRAGO WELLNESS INITIATIVE, LLC
Practice address
W6240 Communication CT Ste 2
Appleton, WI 54914-8549
Phone
(920) 428-0580
NPI assigned
Sep 19, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Authorized official

Name
Dr. Casey HansonNPI 1336331248
Title
Psychologist/Owner
Phone
(920) 428-0580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

W6240 Communication CT Ste 2
Appleton, WI 54914-8549

Mailing address

W6240 Communication CT Ste 2
Appleton, WI 54914-8549

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240102000604 WI Part B Supplier - Clinic/Group Practice 0749630853 Receives reassigned benefits from 4 practitioners
Practice locations: Appleton, WI

National Provider Directory

National Provider Directory

Locations

W6240 Communication Ct
Ste 2
Appleton, WI 54914
Phone (920) 364-0747

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1285412411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W6240 COMMUNICATION CT STE 2",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W6240 COMMUNICATION CT STE 2",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148549",
            "telephone_number": "920-428-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRAGO WELLNESS INITIATIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "920-428-0580",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.