Individual provider Active NPI

Kelly L Kuehl, MSW, LCSW

  • Clinical Social Worker
  • Waukesha, WI
National Provider Identifier
1366740649
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8096-123 Issued in WI
Practice address
N14W23777 Stone Ridge Dr Ste 290
Waukesha, WI 53188-1140
Phone
(414) 667-5809
Fax
(262) 393-2462
NPI assigned
Mar 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8096-123 WI Primary

Addresses

Primary practice location

N14W23777 Stone Ridge Dr Ste 290
Waukesha, WI 53188-1140

Mailing address

N14W23777 Stone Ridge Dr Ste 290
Waukesha, WI 53188-1140
Phone (414) 667-5809

Other names 1

  • Kelly L Simms Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190109000144 WI Practitioner - Clinical Social Worker 9335485515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Empyrean Ventures, IncGroup PAC ID 9537600382, 9 clinicians

Practice addresses (Care Compare)

N14W23777 Stone Ridge Dr
Suite 290
Waukesha, WI 53188-1140
Phone (414) 667-5809

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8096-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Empyrean Ventures Inc Clinical CurrentSince Oct 1, 2024 Accepting new patients
Bell Therapy Family Care Cmu Past Accepting new patients
Broadstep-Wisconsin, Inc. Past Accepting new patients

Locations

N14W23777 Stone Ridge Dr
Ste 290
Waukesha, WI 53188
Phone (262) 716-7580

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1366740649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N14W23777 STONE RIDGE DR STE 290",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881140",
            "telephone_number": "414-667-5809",
            "fax_number": "262-393-2462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N14W23777 STONE RIDGE DR STE 290",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881140",
            "telephone_number": "414-667-5809",
            "fax_number": "262-393-2462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUEHL",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-10",
        "last_updated": "2024-09-06",
        "certification_date": "2024-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8096-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SIMMS",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.