Kellie Elaine Deitrich, MS

Primary specialty

CounselorTaxonomy code 101Y00000X

License

5124-226 Issued in WI

Practice address

2155 E Main St
Reedsburg, WI 53959-9440

Phone

(608) 415-9956

NPI assigned

Jan 19, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sauk CountyGroup PAC ID 7618931148, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Sauk County

  • Skilled Nursing Facility
  • Reedsburg, WI
  • NPI 1528056819
  Medicare reassignment Care Compare group NPD
• County of Sauk

  • Community/Behavioral Health Agency
  • Baraboo, WI
  • NPI 1508915323
  NPD
• Sauk County

  • Public Health or Welfare Agency
  • Baraboo, WI
  • NPI 1962535088
  NPD

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1376295683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MARY AVE",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "539591119",
            "telephone_number": "608-415-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 E MAIN ST",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "539599440",
            "telephone_number": "608-415-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICH",
        "first_name": "KELLIE",
        "middle_name": "ELAINE",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "5124-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dean Health Systems, Inc.
• Maggie Elizabeth Dederich, COTA, LMT
• Lisa Marie Dehn, DPT
• Kaylynn Deitelhoff
• Lacey Deitelhoff
• Nicole Lee Dempsey, CEP
• Elizabeth Dingwall, PA-C
• Jessica L Dominguez
• Karlee Dulak, PHARMD
• Christina Marie Eckes, CADC II, LPC

• Counselor in Reedsburg, WI
• Providers in Reedsburg, WI by specialty
• Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.