Active NPI
Elizabeth Nelson
- Professional Counselor
- Fond Du Lac, WI
National Provider Identifier
1699369215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 11007-125
- Practice address
- 206 6TH St
Fond Du Lac, WI 54935-5174 - Phone
- (920) 204-6393
- NPI assigned
- Feb 24, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 11007-125 | WI | Primary |
Addresses
Primary practice location
206 6TH St
Fond Du Lac, WI 54935-5174
Mailing address
206 6TH St
Fond Du Lac, WI 54935-5174
Phone (920) 204-6393
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11007-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1699369215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 6TH ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549355174",
"telephone_number": "920-204-6393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 6TH ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549355174",
"telephone_number": "920-204-6393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-24",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "11007-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.