NPIMap

Organization Active NPI

Family Services of Northeast Wi, Inc

  • Counselor
  • Green Bay, WI
National Provider Identifier
1679769343
Registry record updated Sep 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
3851-125 Issued in WI
Legal business name
FAMILY SERVICES OF NORTHEAST WI, INC
Practice address
3430 Spirit Way
Green Bay, WI 54304-5687
Phone
(920) 330-0339
NPI assigned
Sep 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2007

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

Authorized official

Name
Katherine K Jensen, LPC
Title
Licensed Professional Counselor
Phone
(920) 330-0339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 3851-125 WI Primary

Addresses

Primary practice location

3430 Spirit Way
Green Bay, WI 54304-5687

Mailing address

3430 Spirit Way
Green Bay, WI 54304-5687
Phone (920) 330-0339

Other identifiers 1

IdentifierTypeStateIssuer
43713200MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Family SVCS of NE Wisco10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1679769343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 SPIRIT WAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045687",
            "telephone_number": "920-330-0339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 SPIRIT WAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045687",
            "telephone_number": "920-330-0339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICES OF NORTHEAST WI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "920-330-0339",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WI",
            "license": "3851-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43713200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.

Verify at the official NPI Registry.