Individual provider Active NPI

Ellen Claire Pederson-Lewis, LCSW

  • Marriage & Family Therapist
  • Brookfield, WI
National Provider Identifier
1649306317
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
401-124 Issued in WI
Practice address
675 N Brookfield Rd
Ste 101
Brookfield, WI 53045-5858
Phone
(262) 641-9300
Fax
(262) 641-9307
NPI assigned
Feb 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1679-123 WI
Marriage & Family Therapist 106H00000X 401-124 WI Primary

Addresses

Primary practice location

675 N Brookfield Rd
Ste 101
Brookfield, WI 53045-5858

Mailing address

7717 N Boyd Way
Fox Point, WI 53217-3210
Phone (414) 690-2197

Other identifiers 1

IdentifierTypeStateIssuer
39296900MedicaidWI

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
1679-123WIMDClinical Social Worker
401-124WIMDMarriage & Family Therapist
1679WIMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Holistic Wellness Center LLC Past Accepting new patients
Associates in Holistic Healthcare, LLC Past Accepting new patients

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1649306317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7717 N BOYD WAY",
            "city": "FOX POINT",
            "state": "WI",
            "postal_code": "532173210",
            "telephone_number": "414-690-2197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N BROOKFIELD RD",
            "address_2": "STE 101",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455858",
            "telephone_number": "262-641-9300",
            "fax_number": "262-641-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON-LEWIS",
        "first_name": "ELLEN",
        "middle_name": "CLAIRE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1679-123",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "401-124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39296900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.