Caroline Chalk, LPC-IT, SAC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4651-226 Issued in WI

Practice address

400 S Townline Rd
Wautoma, WI 54982-6922

Phone

(920) 787-5514

NPI assigned

Feb 24, 2021

Last updated

Feb 24, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

University of Wisconsin School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1316531932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826922",
            "telephone_number": "920-787-5514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826922",
            "telephone_number": "920-787-5514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 W. Lake St",
            "address_purpose": "LOCATION",
            "city": "Friendship",
            "state": "WI",
            "postal_code": "53934",
            "country_code": "US",
            "telephone_number": "608-474-4355",
            "fax_number": "608-474-4309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHALK",
        "first_name": "CAROLINE",
        "credential": "LPC-IT, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-24",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19114-130",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4651-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Bruening, RDH
• Kathleen Busse, RDH
• Joseph W Caron, MD
• Cedar Pines Inc.
• Cedar Pines, Inc
• Chiroplus Complementary Healthcare Centers, LLC
• Chiropractic Health and Wellness Center of Wautoma, Inc
• Renny Cho, DDS
• Thomas G Chulski, MD
• Alma Church, RDH

• Professional Counselor in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.