Active NPI
Connie L Nelson, CADCIII
- Addiction (Substance Use Disorder) Counselor
- Wisconsin Rapids, WI
National Provider Identifier
1619043999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 11628
- Practice address
- 2611 12TH St S
Wisconsin Rapids, WI 54494 - Phone
- (715) 421-8840
- Fax
- (715) 421-2266
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11628 | WI | Primary |
Addresses
Primary practice location
2611 12TH St S
Wisconsin Rapids, WI 54494
Mailing address
2611 12TH St S
Wisconsin Rapids, WI 54494
Phone (715) 421-8840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39386800 | Medicaid | WI |
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 |
|---|---|---|---|
| 11628 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619043999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2611 12TH ST S",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "54494",
"telephone_number": "715-421-8840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2611 12TH ST S",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "54494",
"telephone_number": "715-421-8840",
"fax_number": "715-421-2266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "CONNIE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "CADCIII",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "11628",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39386800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wisconsin Rapids, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.