Gregory Dezell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9553-123 Issued in WI

Practice address

1190 Prairie St
Prairie Du Sac, WI 53578-2044

Phone

(608) 370-6551

NPI assigned

Feb 17, 2021

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychology Clinic Inc.

  • Clinic/Center
  • Madison, WI
  • NPI 1336222769
  Medicare reassignment NPD
• Christianson Pfau Chiropractic LLC

  • Chiropractor
  • Prairie Du Sac, WI
  • NPI 1437272341
  NPD (past)
• Kayla Johnson LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hartland, WI
  • NPI 1356296354
  NPD (past)

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1699368050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N MIDVALE BLVD STE 202",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053265",
            "telephone_number": "608-852-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 PRAIRIE ST",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535782044",
            "telephone_number": "608-370-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZELL",
        "first_name": "GREGORY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9553-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dean Health Systems, Inc. (SSM Health Dean Medical Group Specialty Services - Sauk Prairie)
• Dean Retail Services Inc (SSM Health Davis Duehr Dean Eye Care)
• Henry Clay Dean V, M.D.
• Gina Marie Degiovanni, M.D.
• Elizabeth Christine Deroche, OTR/L
• Bridget Ann Dollar, APNP
• E-Scripts, Inc (Eannelli Pharmacy)
• E-Scripts, Inc
• Eagleview Dental Office
• Michael A Eannelli Sr., RPH

• Clinical Social Worker in Prairie Du Sac, WI
• Providers in Prairie Du Sac, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.