Individual provider Active NPI

Katie Ralph, LPC

  • Professional Counselor
  • Kenosha, WI
National Provider Identifier
1730822693
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11365 Issued in WI
Practice address
2108 63Rd St
Kenosha, WI 53143-4454
Phone
(262) 652-2406
NPI assigned
Apr 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 19804-130 WI
Professional Counselor 101YP2500X 11365 WI Primary
Counselor 101Y00000X 5295 WI

Addresses

Primary practice location

2108 63Rd St
Kenosha, WI 53143-4454

Mailing address

6233 39TH Ave
Kenosha, WI 53142-7015
Phone (262) 654-1004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19804-130WIMDAddiction (Substance Use Disorder) Counselor
11365WIMDProfessional Counselor
5295WIMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. Addiction (Substance Use Disorder) CurrentSince Oct 21, 2024 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1730822693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 63RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434454",
            "telephone_number": "262-652-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RALPH",
        "first_name": "KATIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19804-130",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "11365",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "5295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.