Sara N Jettawi, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

10456-125 Issued in WI

Practice address

2108 63Rd St
Kenosha, WI 53143-4454

Phone

(262) 652-2406

NPI assigned

Oct 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Sara Salzman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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 and National Provider Directory roles.

• Professional Services Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1619024262
  NPD
• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1447912480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETTAWI",
        "first_name": "SARA",
        "middle_name": "N",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "10456-125",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "5035-226",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "10456-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "SALZMAN",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurie Anne Jensen, ATC
• Jeranek Family Chiropractic, LLC
• Janet L Jeranek-Delgreco, D.C.
• Jeremy a Schwartz DPM Wisconsin LTD
• Kristina Lynn Jerry
• Patricia L. Jindrich, LPC
• Amber Jirschele, NP
• Debra Johansen, PHD
• John C Matteucci Jr MD SC
• John P Rende DDS SC

• Counselor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.