NPIMap

Organization Active NPI

Northland Community Services Inc

  • Clinical Psychologist
  • Westfield, WI
National Provider Identifier
1700839644
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
822 Issued in WI
Legal business name
NORTHLAND COMMUNITY SERVICES INC
Practice address
161 Spring St
Westfield, WI 53964-9068
Phone
(608) 296-2139
Fax
(608) 296-1590
NPI assigned
May 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jon S Matthew, PH.DNPI 1598899197
Title
Director
Phone
(608) 296-2139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 822 WI Primary

Addresses

Primary practice location

161 Spring St
Westfield, WI 53964-9068

Mailing address

161 Spring St
PO Box 248
Westfield, WI 53964-9068
Phone (608) 296-2139

Other identifiers 1

IdentifierTypeStateIssuer
42119500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Northland Community Ser6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

161 Spring St
Westfield, WI 53964
Phone (608) 296-2139

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700839644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 SPRING ST",
            "address_2": "PO BOX 248",
            "city": "WESTFIELD",
            "state": "WI",
            "postal_code": "539649068",
            "telephone_number": "608-296-2139",
            "fax_number": "608-296-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 SPRING ST",
            "city": "WESTFIELD",
            "state": "WI",
            "postal_code": "539649068",
            "telephone_number": "608-296-2139",
            "fax_number": "608-296-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND COMMUNITY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATTHEW",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "608-296-2139",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42119500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.