Individual provider Active NPI

Kristen L Vesbach, MS, LPC, ATR-L

  • Professional Counselor
  • Fitchburg, WI
National Provider Identifier
1336416635
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5219-125 Issued in WI
Practice address
2976 Triverton Pike Dr
Suite 119
Fitchburg, WI 53711-5840
Phone
(262) 719-6569
Fax
(608) 286-1088
NPI assigned
Nov 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 97-36 WI
Professional Counselor 101YP2500X 5219-125 WI Primary

Addresses

Primary practice location

2976 Triverton Pike Dr
Suite 119
Fitchburg, WI 53711-5840

Mailing address

6692 Fairway Cir
Windsor, WI 53598-9740

Other identifiers 1

IdentifierTypeStateIssuer
1336416635MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 8, 2024 through Jan 8, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
97-36WIMDMental Health Counselor
5219-125WIMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448928000000",
    "number": "1336416635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6692 FAIRWAY CIR",
            "city": "WINDSOR",
            "state": "WI",
            "postal_code": "535989740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 TRIVERTON PIKE DR",
            "address_2": "SUITE 119",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115840",
            "telephone_number": "262-719-6569",
            "fax_number": "608-286-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VESBACH",
        "first_name": "KRISTEN",
        "middle_name": "L",
        "credential": "MS, LPC, ATR-L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-30",
        "last_updated": "2015-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "97-36",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5219-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336416635",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitchburg, WI

Sources for this page

Verify at the official NPI Registry.