Active NPI
Kelly Wilson
- Mental Health Counselor
- Dubuque, IA
National Provider Identifier
1306612254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 123862
- Practice address
- 210 Jones St Ste 108
Dubuque, IA 52001-7615 - Phone
- (563) 265-8694
- NPI assigned
- Dec 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 123862 | IA | Primary |
Addresses
Primary practice location
210 Jones St Ste 108
Dubuque, IA 52001-7615
Mailing address
820 Laurel St
Dubuque, IA 52003-7947
Phone (563) 663-7445
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://lifeconnections.kasa-solutions.com/index.php | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1659031094
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704240000000",
"number": "1306612254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 LAUREL ST",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520037947",
"telephone_number": "563-663-7445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 JONES ST STE 108",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520017615",
"telephone_number": "563-265-8694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-01",
"last_updated": "2024-01-03",
"certification_date": "2024-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "123862",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://lifeconnections.kasa-solutions.com/index.php",
"affiliation": "N",
"endpointDescription": "EHR System - Kasa Practice Solutions",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "215 4th Ave SE",
"city": "Cedar Rapids",
"state": "IA",
"country_code": "US",
"postal_code": "524011844",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dubuque, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.