Kaleena J Vanderwyst, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5197 Issued in WI

Practice address

730 Swede Ave
Turtle Lake, WI 54889-0000

Phone

(715) 986-2599

Fax

(715) 986-2521

NPI assigned

Jan 14, 2022

Last updated

Jun 10, 2024By 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 1

Addresses

Other identifiers 2

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

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Lakes Community Health Center IncGroup PAC ID 0840366654, 104 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Iron River, WI
  • NPI 1811178825
  Medicare reassignment Care Compare group NPD
• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD
• The Lakes Community Health Center, Inc

  dba Northlakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Turtle Lake, WI
  • NPI 1033569124
  NPD (past)

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

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1598416240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15735 W US HIGHWAY 63",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436475",
            "telephone_number": "715-634-2541",
            "fax_number": "715-934-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 SWEDE AVE",
            "city": "TURTLE LAKE",
            "state": "WI",
            "postal_code": "548890000",
            "telephone_number": "715-986-2599",
            "fax_number": "715-986-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWYST",
        "first_name": "KALEENA",
        "middle_name": "J",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-14",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100191525",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE (LPC)",
            "identifier": "11071",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neha Solanki, DDS
• St. Croix Chippewa Indians of Wi (Stctx)
• Kayla S Steinberger, OTR/L
• The Lakes Community Health Center, Inc (Northlakes Community Clinic)
• Tessa Traynor, DPT
• Robert Edward Vogel
• Carla M Vossen, FNP
• Melissa Waytashek, MS, LAT, ATC
• Noah Zehringer

• Professional Counselor in Turtle Lake, WI
• Providers in Turtle Lake, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.