Active NPI
Avery Reven Kowalke, LICENSED PROFESSIONA
- Professional Counselor
- Monona, WI
National Provider Identifier
1568008886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6438-125
- Practice address
- 6400 Gisholt Dr Ste 100
Monona, WI 53713-4800 - Phone
- (608) 669-5499
- NPI assigned
- Nov 21, 2019
- Last updated
- Sep 24, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6438-125 | WI | Primary |
Addresses
Primary practice location
6400 Gisholt Dr Ste 100
Monona, WI 53713-4800
Mailing address
1914 Dolores Dr
Madison, WI 53716-2318
Phone (608) 669-5499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6438-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1568008886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1914 DOLORES DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537162318",
"telephone_number": "608-669-5499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6400 GISHOLT DR STE 100",
"city": "MONONA",
"state": "WI",
"postal_code": "537134800",
"telephone_number": "608-669-5499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOWALKE",
"first_name": "AVERY",
"middle_name": "REVEN",
"credential": "LICENSED PROFESSIONA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-21",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "6438-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.