Individual provider Active NPI

Dawn Miller-Duval, LPC

  • Professional Counselor
  • Kenosha, WI
National Provider Identifier
1417484155
Registry record updated May 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3040125 Issued in WI
Practice address
2108 63Rd St
Kenosha, WI 53143-4454
Phone
(262) 652-2406
Fax
(262) 652-2408
NPI assigned
May 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3040125 WI Primary

Addresses

Primary practice location

2108 63Rd St
Kenosha, WI 53143-4454

Mailing address

2108 63Rd St
Kenosha, WI 53143-4454
Phone (262) 652-2406

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
I20240209002373 WI Practitioner - Mental Health Counselor 9133562853 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3040125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. CurrentSince Jan 26, 2024 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

1205 S 70th St
Ste 301
West Allis, WI 53214
Phone (414) 475-2788

Organizations & group practices 1

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": "1494547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494547200000",
    "number": "1417484155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 63RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434454",
            "telephone_number": "262-652-2406",
            "fax_number": "262-652-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 63RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434454",
            "telephone_number": "262-652-2406",
            "fax_number": "262-652-2408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER-DUVAL",
        "first_name": "DAWN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-12",
        "last_updated": "2017-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3040125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.