Ivy Ellen Jean Phelps, LCSW, CSAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15687-132 Issued in WI

Practice address

2814 S 108TH St
West Allis, WI 53227-3224

Phone

(414) 885-3525

NPI assigned

Jul 5, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ivy Ellen Jean Sturgen (Previous) (Married Name) Former name

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Richard Kneip PHD PCGroup PAC ID 4880768415, 243 clinicians

Practice addresses (Care Compare)

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.

• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700

  WI

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1720509292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2814 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273224",
            "telephone_number": "414-885-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2814 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273224",
            "telephone_number": "414-885-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1610 Miller Park Way",
            "address_purpose": "LOCATION",
            "city": "West Milwaukee",
            "state": "WI",
            "postal_code": "532143604",
            "country_code": "US",
            "telephone_number": "414-672-3801",
            "fax_number": "414-672-6026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "IVY",
        "middle_name": "ELLEN JEAN",
        "credential": "LCSW, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-05",
        "last_updated": "2022-07-21",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15687-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVY",
            "last_name": "STURGEN (PREVIOUS) (MARRIED NAME)",
            "middle_name": "ELLEN JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maria Angelica Peterson
• Alexandra Marie Petrie
• Kathryn Anne Petzold, MS, LPC
• Lee Pha
• Pharos Enterprises of Wisconsin, LLC (Envision Surgery Center)
• John J Pickeral, MD
• Brenda M. Pierce, MD
• Craig Alan Pierstorff, M.D.
• Jane A Pipke, RN
• Amanda Pisula

• Addiction (Substance Use Disorder) Counselor in West Allis, WI
• Providers in West Allis, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.