Individual provider Active NPI

Bradley D Klinger, MA

  • Professional Counselor
  • Brown Deer, WI
National Provider Identifier
1558774075
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11068 Issued in WI
Practice address
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone
(414) 540-2170
Fax
(414) 540-2171
NPI assigned
Jun 3, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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 11068 WI Primary

Addresses

Primary practice location

3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220

Mailing address

3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone (414) 540-2170

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
I20241118000061 WI Practitioner - Mental Health Counselor 1759815475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shorehaven Behavioral Health IncGroup PAC ID 0143324954, 12 clinicians

Practice addresses (Care Compare)

3900 W Brown Deer Rd
Suite 200
Brown Deer, WI 53209-1220
Phone 4145402170256

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
11068WIMDProfessional Counselor

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1558774075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINGER",
        "first_name": "BRADLEY",
        "middle_name": "D",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "11068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown Deer, WI

Sources for this page

Verify at the official NPI Registry.