Individual provider Active NPI

Candy Ann Kennedy, M.A.

  • Professional Counselor
  • Milwaukee, WI
National Provider Identifier
1639473234
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
525226 Issued in WI
Practice address
6040 W Lisbon Ave
Milwaukee, WI 53210-2116
Phone
(414) 871-9111
Fax
(414) 871-9121
NPI assigned
Dec 22, 2010
Last updated
Dec 22, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 525226 WI Primary

Addresses

Primary practice location

6040 W Lisbon Ave
Milwaukee, WI 53210-2116

Mailing address

6040 W Lisbon Ave
Milwaukee, WI 53210-2116
Phone (414) 871-9111

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
I20240514003495 WI Practitioner - Mental Health Counselor 2163863796 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
525226WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Abg Wellness Group Inc CurrentSince Apr 19, 2024 Accepting new patients

Locations

11414 W Park Pl
Ste 202
Milwaukee, WI 53224
Phone (414) 292-7060

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1639473234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532102116",
            "telephone_number": "414-871-9111",
            "fax_number": "414-871-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532102116",
            "telephone_number": "414-871-9111",
            "fax_number": "414-871-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CANDY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-22",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "525226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.