Individual provider Active NPI

Lee A Kutchenriter, LCSW

  • Clinical Social Worker
  • Menasha, WI
National Provider Identifier
1376069930
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9930-123 Issued in WI
Practice address
1095 Midway Rd
Menasha, WI 54952-1115
Phone
(920) 720-2300
NPI assigned
Aug 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9930-123 WI Primary
Social Worker 104100000X 6801101371

Addresses

Primary practice location

1095 Midway Rd
Menasha, WI 54952-1115

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 720-2300

Other practice location 1

3329 N Richmond St
Appleton, WI 54911-1063
Phone (920) 380-2715

Other identifiers 1

IdentifierTypeStateIssuer
100089227MedicaidWI

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
I20200208000180 WI Practitioner - Clinical Social Worker 0648606715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1095 Midway Rd
Menasha, WI 54952-1115
Phone (920) 720-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince May 5, 2023 Accepting new patients
Thedacare, Incorporated Social Worker CurrentSince May 5, 2023 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1095 Midway Rd
Menasha, WI 54952
Phone (920) 720-3700

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

Organizations & group practices 2

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": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1376069930",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521115",
            "telephone_number": "920-720-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3329 N Richmond St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549111063",
            "country_code": "US",
            "telephone_number": "920-380-2715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUTCHENRITER",
        "first_name": "LEE",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-16",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9930-123",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": "6801101371",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100089227",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.