Kimberly Sue Wasoski, LMHC, LCAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39000873A Issued in IN

Practice address

3220 E Jefferson Blvd
South Bend, IN 46615-3028

Phone

(574) 222-2466

Fax

(574) 222-2468

NPI assigned

Nov 1, 2007

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 3

Medicare fee-for-service enrollment

Enrolled in IN

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, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Reflections CounselingGroup PAC ID 1153624812, 6 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 and National Provider Directory roles.

• Reflections Counseling

  • Community/Behavioral Health Agency
  • South Bend, IN
  • NPI 1023428711
  Medicare reassignment Care Compare group NPD
• Dr Heather Holleman LLC

  • Clinical Psychologist
  • South Bend, IN
  • NPI 1942999636
  NPD

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1639358161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 E. JEFFERSON BLVD.",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152733",
            "telephone_number": "574-222-2466",
            "fax_number": "574-222-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466153028",
            "telephone_number": "574-222-2466",
            "fax_number": "574-222-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASOSKI",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "LMHC, LCAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39000873A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "000000542441",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200375890A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000542441",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas B Was, LMHC
• Barbara A Wascisin Hernly, LSW
• Cassandra Washington
• Jerica Washington, RBT
• Yolanda Gelaine Washington, RN
• Madeline Christina Watkins, LMHC
• Anne Margaret Watson, MSW, LCSW
• Caylee S Watson, NP
• Jessi Watson
• Patrick John Watson, MD

• Mental Health Counselor in South Bend, IN
• Providers in South Bend, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.