Kelsey Stange, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3323-57 Issued in WI

Practice address

2925 Columbia Dr
Portage, WI 53901-9485

Phone

(608) 742-9100

NPI assigned

Apr 19, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelsey Johnston Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Columbia Correctional Institution

  dba Cci

  • Clinic/Center
  • Portage, WI
  • NPI 1760522452
  NPD (past)

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1407380116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 COLUMBIA DR",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 COLUMBIA DR",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019485",
            "telephone_number": "608-742-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4439 Snowy Ridge Trl",
            "address_purpose": "LOCATION",
            "city": "Windsor",
            "state": "WI",
            "postal_code": "535989694",
            "country_code": "US",
            "telephone_number": "320-583-1968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANGE",
        "first_name": "KELSEY",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3323-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "JOHNSTON",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beatriz Somoza-Blanco, MD
• Amy Sonnenberg
• Rebecca J Spaeth, COTA
• Lauren Sperstad
• Claire A Staley, APSW
• Lisa Marie Stangler, OTR
• Bonnie Sue Stanislawski, AU. D.
• Terrel A Steinhaus, OT
• Darcy L Steinhorst, PA-C
• Honey Sternberg, LPC

• Clinical Psychologist in Portage, WI
• Providers in Portage, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.