Individual provider Active NPI

Kathleen M Sayers, MSW LCSW LMFT

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1720078074
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
497-124 Issued in WI
Practice address
2640 W Point Rd
Green Bay, WI 54304-1344
Phone
(920) 490-3790
NPI assigned
Oct 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 497-124 WI Primary

Addresses

Primary practice location

2640 W Point Rd
Green Bay, WI 54304-1344

Mailing address

PO Box 365
Oneida, WI 54155-0365
Phone (920) 490-3790

Other identifiers 1

IdentifierTypeStateIssuer
39692700MedicaidWI

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
497-124WIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1720078074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541550365",
            "telephone_number": "920-490-3790",
            "fax_number": "920-490-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 W POINT RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543041344",
            "telephone_number": "920-490-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAYERS",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "MSW LCSW LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "497-124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39692700",
            "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 Mar 31, 2022; 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.