Scott Alan Ethun, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

2217-123 Issued in WI

Practice address

302 W Lake St
Friendship, WI 53934

Phone

(608) 474-4355

NPI assigned

Jun 17, 2010

Last updated

Mar 29, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Goodman's Behavioral Health Clinic, LLC

  • Community/Behavioral Health Agency
  • Reedsburg, WI
  • NPI 1740458363
  Medicare reassignment NPD
• Trailways LLC

  dba Trailways Counseling

  • Mental Health Counselor
  • Waunakee, WI
  • NPI 1639790256
  Medicare reassignment NPD
• Trauma Life Consulting

  dba Trauma Life Consulting LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waunakee, WI
  • NPI 1336930304
  NPD (past)

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553817600000",
    "number": "1447571062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "JUNEAU COUNTY DEPT OF HUMAN SERVICES",
            "address_2": "200 HICKORY ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "53948",
            "telephone_number": "608-847-2400",
            "fax_number": "608-847-9421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W LAKE ST",
            "city": "FRIENDSHIP",
            "state": "WI",
            "postal_code": "53934",
            "telephone_number": "608-474-4355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Juneau County Dept of Human Services",
            "address_2": "200 Hickory St",
            "address_purpose": "LOCATION",
            "city": "Mauston",
            "state": "WI",
            "postal_code": "53948",
            "country_code": "US",
            "telephone_number": "608-847-2400",
            "fax_number": "608-847-9421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHUN",
        "first_name": "SCOTT",
        "middle_name": "ALAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "2217-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven K Dankle, MD
• Robert E Docherty, RN
• Jamie Lynn Donnelly
• Barbara A Drolson, RN
• Kaye Marie Eckert, PSY.D.
• Mary L. Fendt, PT
• Alicia-Maria Fernandez, D.O.
• Mary Lynn Forstner, MS/CCC-SLP
• Arthur Thomas Foster Sr., LMFT, SACIT
• Kari A. Gatterman, PT

• Social Worker in Friendship, WI
• Providers in Friendship, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.