NPIMap

Organization Active NPI

Wellness West LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukesha, WI
National Provider Identifier
1306569629
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WELLNESS WEST LLC
Practice address
2428 N Grandview Blvd Ste 101
Waukesha, WI 53188-6906
Phone
(262) 259-4100
NPI assigned
Sep 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Jennifer Vann, PSYDNPI 1922451285
Title
Owner/Psychologist
Phone
(262) 259-4100

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

2428 N Grandview Blvd Ste 101
Waukesha, WI 53188-6906

Mailing address

2428 N Grandview Blvd Ste 101
Waukesha, WI 53188-6906
Phone (262) 259-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221122001246 WI Part B Supplier - Clinic/Group Practice 4789052820 Receives reassigned benefits from 7 practitioners
Practice locations: Waukesha, WI

National Provider Directory

National Provider Directory

Locations

2428 N Grandview Blvd
Ste 101
Waukesha, WI 53188
Phone (262) 259-4100

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1306569629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 N GRANDVIEW BLVD STE 101",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531886906",
            "telephone_number": "262-259-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 N GRANDVIEW BLVD STE 101",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531886906",
            "telephone_number": "262-259-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS WEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "VANN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "262-259-4100",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.