Individual provider Active NPI

Michelle M Matthews, LCSW

  • Clinical Social Worker
  • Kenosha, WI
National Provider Identifier
1528100641
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7334-123 Issued in WI
Practice address
4109 67TH St
Kenosha, WI 53142-3836
Phone
(262) 652-9830
Fax
(262) 652-2931
NPI assigned
Feb 13, 2007
Last updated
Aug 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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 7334-123 WI Primary

Addresses

Primary practice location

4109 67TH St
Kenosha, WI 53142-3836

Mailing address

3341 N 85TH St
Milwaukee, WI 53222-3708
Phone (414) 837-5227

Other identifiers 1

IdentifierTypeStateIssuer
43739800MedicaidWI

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
I20210126000715 WI Practitioner - Clinical Social Worker 4385058742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
May accept Medicare assignment
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians
Oakwood Clinical Associates, LTDGroup PAC ID 8022084383, 3 clinicians

Practice addresses (Care Compare)

2130 Big Bend Rd
Waukesha, WI 53189-7624
Phone (262) 928-7555

4109 67TH St
Kenosha, WI 53142-3836
Phone (262) 652-9830

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Clinical Associates, LTD Clinical CurrentSince Jan 8, 2021 Accepting new patients
Prohealth Medical Group Inc CurrentSince Oct 1, 2025 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Oct 1, 2025 Accepting new patients

Locations

4109 67th St
Kenosha, WI 53142
Phone (262) 652-9830

2130 Big Bend Rd
Waukesha, WI 53189
Phone (262) 928-7555

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Organizations & group practices 3

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1528100641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3341 N 85TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532223708",
            "telephone_number": "414-837-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 67TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423836",
            "telephone_number": "262-652-9830",
            "fax_number": "262-652-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7334-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43739800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.