Katie Koebernik, LPC-IT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2593-226 Issued in WI

Practice address

424 S Monroe Ave Ste 201
Green Bay, WI 54301-4054

Phone

(920) 445-0170

Fax

(920) 445-0174

NPI assigned

Nov 4, 2015

Last updated

Oct 9, 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 2

Addresses

Other identifiers 1

Other names 1

• Katie Kordus Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1427421023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2691 VIOLET LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543136080",
            "telephone_number": "479-305-3081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 S MONROE AVE STE 201",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014054",
            "telephone_number": "920-445-0170",
            "fax_number": "920-445-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEBERNIK",
        "first_name": "KATIE",
        "credential": "LPC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18335-130",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "2593-226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427421023",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "KORDUS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karisa J Koch, LPC-IT
• Paul David Koch, M.D.
• Leslie A Kocha, APSW
• Katie S Kocian, MAC, LPC
• Angela M Koebe, COTA
• Delilah Koehler, CCC-SLP
• Michelle Lee Koehler, OTR
• Natasha M Koehler, N.P.
• Samantha Rose Koehn, SAC-IT
• Cindy Marie Koerner, CCC SLP

• Mental Health Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.