Individual provider Active NPI

Angela Quinn

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1467938811
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
131103-121 Issued in WI
Practice address
1499 6TH St
Green Bay, WI 54304-2252
Phone
(920) 497-6161
NPI assigned
Jul 18, 2018
Last updated
Jul 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 131103-121 WI Primary

Addresses

Primary practice location

1499 6TH St
Green Bay, WI 54304-2252

Mailing address

1499 6TH St
Green Bay, WI 54304-2252
Phone (920) 497-6161

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210716000186 WI Practitioner - Clinical Social Worker 3971905779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Innovative Counseling IncGroup PAC ID 8022154749, 15 clinicians

Practice addresses (Care Compare)

1499 6TH St
Green Bay, WI 54304-2252
Phone (920) 497-6161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
131103-121WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Counseling Inc CurrentSince Jun 16, 2021 Accepting new patients

Locations

1499 6th St
Green Bay, WI 54304
Phone (920) 497-6161

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1467938811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINN",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "131103-121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.