Samantha Lynn Klockow, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3983-57 Issued in WI

Practice address

4131 W Loomis Rd Apt 120
Greenfield, WI 53221-2006

Phone

(414) 424-2445

Fax

(414) 424-2446

NPI assigned

Sep 28, 2017

Last updated

Jul 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightside Medical PAGroup PAC ID 3678948809, 92 clinicians

Nystrom and Associates Counseling Wi SCGroup PAC ID 1052729464, 108 clinicians

Practice addresses (Care Compare)

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.

• Nystrom & Associates Counseling Wi., S.C.

  dba Nystrom & Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Crosse, WI
  • NPI 1659977866
  Medicare reassignment Care Compare group NPD
• Brightside Medical, P.a.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1609335660

  WI

  Medicare reassignment Care Compare group NPD
• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment NPD
• Wisconsin Lutheran Child and Family Service Inc

  dba Christian Family Solutions

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Germantown, WI
  • NPI 1083786628
  Medicare reassignment
• Wisconsin Lutheran Child & Family Service, Inc

  dba Christian Family Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
  • NPI 1750475513
  NPD
• Nystrom & Associates Counseling Wi., S.C.

  dba Sagent Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1104549047
  NPD
• Wisconsin Lutheran Child & Family Service

  dba Christian Family Counseling

  • Psychologist
  • Mankato, MN
  • NPI 1801271515
  NPD (past)

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1457860884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 W LOOMIS RD APT 120",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532212006",
            "telephone_number": "414-424-2445",
            "fax_number": "414-424-2446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCKOW",
        "first_name": "SAMANTHA",
        "middle_name": "LYNN",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "6493",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3983-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn M Kiyono, MD
• Alexis Kleczka, DPT
• Abigail J Kleinschmidt, CPNP-PC
• Connor Patrick Kleman
• Shannon Marie Klipstein
• Douglas A. Kloss, AU.D.
• David T Klumpp, OT
• Mary Kluth, P.T.
• Debra Knapp, APNP
• Katie Marie Knappmiller, R.N.

• Clinical Psychologist in Greenfield, WI
• Providers in Greenfield, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.