Active NPI
Kathleen Gussler Koepke, MSSW, LICSW
- Mental Health Counselor
- Wautoma, WI
National Provider Identifier
1295834539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2337
- Practice address
- 230 W Park St
Wautoma, WI 54982-9031 - Phone
- (920) 787-6550
- Fax
- (920) 787-0421
- NPI assigned
- Sep 22, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2337 | WI | Primary |
| Clinical Social Worker | 1041C0700X | 2337-123 | WI |
Addresses
Primary practice location
230 W Park St
Wautoma, WI 54982-9031
Mailing address
230 Park St
PO Box 1230
Wautoma, WI 54982-9031
Phone (920) 787-6550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39654800 | Medicaid | WI | |
| 84306005 | Other | WI | MEDICARE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2337-123 | WI | MD | Clinical Social Worker |
| 2337 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436400000000",
"number": "1295834539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 PARK ST",
"address_2": "PO BOX 1230",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549829031",
"telephone_number": "920-787-6550",
"fax_number": "920-787-0421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 W PARK ST",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549829031",
"telephone_number": "920-787-6550",
"fax_number": "920-787-0421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEPKE",
"first_name": "KATHLEEN",
"middle_name": "GUSSLER",
"name_prefix": "Ms.",
"credential": "MSSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-22",
"last_updated": "2015-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "2337",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2337-123",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39654800",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "84306005",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wautoma, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.