Mariah M Collicott, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13169-33 Issued in WI

Practice address

20611 Watertown Rd Ste E
Waukesha, WI 53186-1871

Phone

(629) 014-4502

Fax

(262) 901-4451

NPI assigned

Sep 26, 2022

Last updated

Aug 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cleanslate Medical Group of Wisconsin SCGroup PAC ID 4284905134, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cleanslate Medical Group of Wisconsin, SC

  • Addiction Medicine (Internal Medicine) Physician
  • Glendale, WI
  • NPI 1518404854
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1568185403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20611 WATERTOWN RD STE E",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861871",
            "telephone_number": "629-014-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20611 WATERTOWN RD STE E",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861871",
            "telephone_number": "629-014-4502",
            "fax_number": "262-901-4451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1061 E Commerce Blvd",
            "address_purpose": "LOCATION",
            "city": "Slinger",
            "state": "WI",
            "postal_code": "530869326",
            "country_code": "US",
            "telephone_number": "262-644-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLICOTT",
        "first_name": "MARIAH",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "13169-33",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "13169-33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcollicott323986@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1061 E Commerce Blvd",
            "city": "Slinger",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530869326",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1061 E Commerce Blvd",
            "city": "Slinger",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530869326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Lee Claus, LPC
• Ana Nicole Clavijo, MD
• Jayden Mae Clemetson, RDN
• Kathleen Coffey-Guenther, PH.D.
• Edward L Cohen, LCSW
• Elizabeth Amanda Collier, CSAC,ICS,LCSW
• Christopher D Collingwood, DDS
• Margaret Colombe, RPH
• Alex Colque, M.D.
• Come Grow With US Adult Family Home LLC

• Family Nurse Practitioner in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.