Active NPI
Jerry D Youngman, LPC
- Counselor
- Baldwin, WI
National Provider Identifier
1750301693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 448
- Practice address
- 1100 Bergslien St
Baldwin, WI 54002-2600 - Phone
- (715) 684-1111
- Fax
- (715) 684-1119
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 448 | WI | Primary |
Addresses
Primary practice location
1100 Bergslien St
Baldwin, WI 54002-2600
Mailing address
1100 Bergslien St
Baldwin, WI 54002-2600
Phone (715) 684-1111
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 448 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1750301693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 BERGSLIEN ST",
"city": "BALDWIN",
"state": "WI",
"postal_code": "540022600",
"telephone_number": "715-684-1111",
"fax_number": "715-684-1119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 BERGSLIEN ST",
"city": "BALDWIN",
"state": "WI",
"postal_code": "540022600",
"telephone_number": "715-684-1111",
"fax_number": "715-684-1119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGMAN",
"first_name": "JERRY",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.