NPIMap

Organization Active NPI

Manifest Wellness, LLC

  • Professional Counselor
  • Madison, WI
National Provider Identifier
1750064283
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MANIFEST WELLNESS, LLC
Practice address
2010 Eastwood Dr Ste 102
Madison, WI 53704-5387
Phone
(608) 291-3676
Fax
(608) 716-3156
NPI assigned
Aug 10, 2023
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Jennifer Klekamp, LPC, SACNPI 1265896138
Title
Owner, Program Director
Phone
(608) 982-7698

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X Primary
Social Worker 104100000X
Marriage & Family Therapist 106H00000X

Addresses

Primary practice location

2010 Eastwood Dr Ste 102
Madison, WI 53704-5387

Mailing address

2010 Eastwood Dr Ste 104
Madison, WI 53704-5387
Phone (608) 291-3676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240819001238 WI Part B Supplier - Clinic/Group Practice 5799223012 Receives reassigned benefits from 5 practitioners
Practice locations: Madison, WI

National Provider Directory

National Provider Directory

Locations

2010 Eastwood Dr
Ste 102
Madison, WI 53704
Phone (608) 291-3676

2010 Eastwood Dr
Ste 104
Madison, WI 53704

2701 International Ln
Ste 105
Madison, WI 53704
Phone (608) 709-1034

2560 E Main St
Ste 6
Reedsburg, WI 53959

Practitioners & affiliated clinicians

Practitioners 11

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": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1750064283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 EASTWOOD DR STE 104",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045387",
            "telephone_number": "608-291-3676",
            "fax_number": "608-716-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 EASTWOOD DR STE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045387",
            "telephone_number": "608-291-3676",
            "fax_number": "608-716-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANIFEST WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "KLEKAMP",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER, PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "608-982-7698",
        "authorized_official_credential": "LPC, SAC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.