Individual provider Active NPI

Jennifer Delfosse

  • Addiction (Substance Use Disorder) Counselor
  • Oshkosh, WI
National Provider Identifier
1427466713
Registry record updated Jul 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
15702-131 Issued in WI
Practice address
220 Washington Ave
Oshkosh, WI 54901-5030
Phone
(920) 236-4728
Fax
(920) 236-1157
NPI assigned
Jul 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 15702-131 WI Primary

Addresses

Primary practice location

220 Washington Ave
Oshkosh, WI 54901-5030

Mailing address

220 Washington Ave
Oshkosh, WI 54901-5030
Phone (920) 236-4728

Other identifiers 1

IdentifierTypeStateIssuer
42139300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
15702-131WIMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
County of Winnebago PastSince Dec 1, 2003 Accepting new patients
Winnebago County Past Accepting new patients

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": "1406678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406678400000",
    "number": "1427466713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 WASHINGTON AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549015030",
            "telephone_number": "920-236-4728",
            "fax_number": "920-236-1157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 WASHINGTON AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549015030",
            "telephone_number": "920-236-4728",
            "fax_number": "920-236-1157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELFOSSE",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15702-131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42139300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.