NPIMap

Organization Active NPI

Oakwood Clinical Associates, LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
National Provider Identifier
1447289434
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
OAKWOOD CLINICAL ASSOCIATES, LTD
Practice address
4109 67TH St
Kenosha, WI 53142-3836
Phone
(262) 652-9830
Fax
(262) 652-2931
NPI assigned
Jul 2, 2006
Last updated
Mar 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Authorized official

Name
Amy B Anderson, MSWNPI 1295766186
Title
Psychotherapist
Phone
(262) 652-9830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X WI Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X WI
Professional Counselor 101YP2500X WI
Clinical Social Worker 1041C0700X WI

Addresses

Primary practice location

4109 67TH St
Kenosha, WI 53142-3836

Mailing address

4109 67TH St
Kenosha, WI 53142-3836
Phone (262) 652-9830

Other identifiers 2

IdentifierTypeStateIssuer
84521OtherWIMEDICARE
42157000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908000656 WI Part B Supplier - Clinic/Group Practice 8022084383 Receives reassigned benefits from 3 practitioners
Practice locations: Kenosha, WI; Salem, WI

National Provider Directory

National Provider Directory

Locations

4109 67th St
Kenosha, WI 53142
Phone (262) 652-9830

24804 75th St
Salem, WI 53168
Phone (262) 652-9830

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1447289434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 67TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423836",
            "telephone_number": "262-652-9830",
            "fax_number": "262-652-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 67TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423836",
            "telephone_number": "262-652-9830",
            "fax_number": "262-652-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKWOOD CLINICAL ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "262-652-9830",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "84521",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42157000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.