Audra A Eggum, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7281-123 Issued in WI

Practice address

140 W Main St
Suite a
Winneconne, WI 54986-9409

Phone

(920) 582-4000

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• The Growing Tree Counseling & Wellness

  • Clinical Social Worker
  • Winneconne, WI
  • NPI 1144531757
  NPD (past) Authorized official

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1457566689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 486",
            "address_2": "140 W MAIN",
            "city": "WINNECONNE",
            "state": "WI",
            "postal_code": "549860486",
            "telephone_number": "920-582-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 W MAIN ST",
            "address_2": "SUITE A",
            "city": "WINNECONNE",
            "state": "WI",
            "postal_code": "549869409",
            "telephone_number": "920-582-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGGUM",
        "first_name": "AUDRA",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1556-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7281-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40923500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ascension Medical Group-Fox Valley Wisconsin, Inc
• Aurora Medical Group, Inc.
• Luke William Berglund
• Patrick Gerard Dowling, DDS
• Ryan Joseph Gonzalez, D.D.S.
• Joseph Walter Guerard, D.D.S.
• David J Hoenecke, RPH
• Alexandra Kellogg, D.C.
• Jennifer Krause

• Clinical Social Worker in Winneconne, WI
• Providers in Winneconne, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.