Individual provider Active NPI

Jennifer Lynn Wendt, MA

  • Professional Counselor
  • Jefferson, WI
National Provider Identifier
1578793964
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC4064-125 Issued in WI
Practice address
1541 Annex Rd
Jefferson, WI 53549-9803
Phone
(920) 674-8717
Fax
(920) 674-2359
NPI assigned
Jul 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC4064-125 WI Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 4064-125 WI

Addresses

Primary practice location

1541 Annex Rd
Jefferson, WI 53549-9803

Mailing address

1541 Annex Rd
Jefferson, WI 53549-9803
Phone (920) 674-8717

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
I20240215000553 WI Practitioner - Mental Health Counselor 5991981722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson CountyGroup PAC ID 2264496801, 19 clinicians

Practice addresses (Care Compare)

1541 Annex Rd
Jefferson, WI 53549-9803
Phone (920) 674-3105

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4064-125WIMDAddiction (Substance Use Disorder) Counselor
LPC4064-125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson County CurrentSince Jan 1, 2024 Accepting new patients
Jefferson County CurrentSince Jan 1, 2024 Accepting new patients

Locations

1541 Annex Rd
Jefferson, WI 53549
Phone (920) 674-3105

Organizations & group practices 2

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": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1578793964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499803",
            "telephone_number": "920-674-8717",
            "fax_number": "920-674-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499803",
            "telephone_number": "920-674-8717",
            "fax_number": "920-674-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDT",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "LPC4064-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "4064-125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, WI

Sources for this page

Verify at the official NPI Registry.