Individual provider Active NPI

Conor Watson

  • Professional Counselor
  • Fond Du Lac, WI
National Provider Identifier
1528764206
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11321-125 Issued in WI
Practice address
371 E 1St St
Fond Du Lac, WI 54935-4563
Phone
(920) 907-3967
NPI assigned
Feb 3, 2023
Last updated
May 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 11321-125 WI Primary

Addresses

Primary practice location

371 E 1St St
Fond Du Lac, WI 54935-4563

Mailing address

40 Camelot Dr
Fond Du Lac, WI 54935-8049
Phone (920) 907-8201

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
I20241011001781 WI Practitioner - Mental Health Counselor 9133651466 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11321-125WIMDProfessional Counselor
11321WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare, Inc Current Accepting new patients
Agnesian Healthcare Inc CurrentSince Sep 27, 2024 Accepting new patients
Agnesian Healthcare Inc CurrentSince Sep 27, 2024 Accepting new patients
Agnesian Healthcare Inc Past Accepting new patients

Locations

371 E 1st St
Fond du Lac, WI 54935
Phone (920) 907-3928

40 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 907-8201

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

525 E Pioneer Rd
Fond du Lac, WI 54935

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

Organizations & group practices 4

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": "1675382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1528764206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358049",
            "telephone_number": "920-907-8201",
            "fax_number": "920-907-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354563",
            "telephone_number": "920-907-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "CONOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-03",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "11321-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.