Active NPI
Kathryn P Vandusartz, MS LPC
- Counselor
- Ellsworth, WI
National Provider Identifier
1285706192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2663-125
- Practice address
- 412 W Kinne St
Ellsworth, WI 54011 - Phone
- (715) 273-6770
- Fax
- (715) 273-6862
- NPI assigned
- Nov 15, 2006
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2663-125 | WI | Primary |
Addresses
Primary practice location
412 W Kinne St
Ellsworth, WI 54011
Mailing address
PO Box 670
Ellsworth, WI 54011-0670
Phone (715) 273-6770
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39748600 | Medicaid | WI | |
| 09G64HA | Other | MN | BLUE CROSS BLUE SHIELD |
| HP70350 | Other | MN | HEALTHPARTNERS |
| 920461021644 | Other | MN | PREFERRED ONE |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2663-125 | WI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1285706192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 670",
"city": "ELLSWORTH",
"state": "WI",
"postal_code": "540110670",
"telephone_number": "715-273-6770",
"fax_number": "715-273-6862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 W KINNE ST",
"city": "ELLSWORTH",
"state": "WI",
"postal_code": "54011",
"telephone_number": "715-273-6770",
"fax_number": "715-273-6862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDUSARTZ",
"first_name": "KATHRYN",
"middle_name": "P",
"credential": "MS LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "2663-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39748600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "09G64HA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP70350",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "920461021644",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ellsworth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.