Jesen Daniel

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5809 125 Issued in WI

Practice address

111 East Washington St
Affiliated Clinical Services
West Bend, WI 53095

Phone

(262) 338-2717

Fax

(262) 338-9767

NPI assigned

Dec 1, 2015

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

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

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Affiliated Clinical Services IncGroup PAC ID 0244124899, 22 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 and National Provider Directory roles.

• Affiliated Clinical Services Inc

  • Multi-Specialty Clinic/Center
  • West Bend, WI
  • NPI 1851473698
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448928000000",
    "number": "1508230632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 EAST WASHINGTON ST",
            "address_2": "AFFILIATED CLINICAL SERVICES",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "53095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EAST WASHINGTON ST",
            "address_2": "AFFILIATED CLINICAL SERVICES",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "53095",
            "telephone_number": "262-338-2717",
            "fax_number": "262-338-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIEL",
        "first_name": "JESEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-01",
        "last_updated": "2015-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "5809 125",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "5809 125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5809 125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe Cusack, MS SLP-CFY
• Melanie Custer, M.D.
• Mary Kathleen Cutler, RN
• Erica Czosnyka
• Kylie Dake, OTR/L
• Sara N. Daniel, M.S.W., L.C.S.W
• Megan L Daniels, DPT
• Kelly Jean Darmody, M.D.
• Darcy Jean Dart, SAC-IT
• Lori Jo Dauss, MS, ATC, LAT

• Professional Counselor in West Bend, WI
• Providers in West Bend, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.