Korah Lee Petrasko, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8166 Issued in WI

Practice address

711 N Lynndale Dr Ste 1a
Appleton, WI 54914-3078

Phone

(920) 560-4525

NPI assigned

Feb 24, 2018

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22083/brand/1/csg/1/fhir/r4

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.

• GJB Eeg Services, SC

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  • NPI 1396315321
  NPD
• GJB Health Services, LLC

  • Psychologist
  • Appleton, WI
  • NPI 1659711687

  Professional

  NPD

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

{
    "created_epoch": "1519430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1346741345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-720-2300",
            "fax_number": "920-720-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N LYNNDALE DR STE 1A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143078",
            "telephone_number": "920-560-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRASKO",
        "first_name": "KORAH",
        "middle_name": "LEE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-24",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3831-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neal Michael Peterson, CRNA
• Richard Peterson
• Sarah Elizabeth Peterson, APSW
• Kirsten D Pethan, PA-C
• Kristen Anne Pethan, CPM
• Laurie J Petrie-Kampa, OTR, CHT
• Mikayla Ruth Petzke, NP
• Michelle A Pevonka-Thompson, BSN, RN
• Andrew Pfaffenbach, M.D.
• Elina Xanos Pfaffenbach, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.

Verify at the official NPI Registry.