Kelly M Gustavson-Mattek, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2533-057 Issued in WI

Practice address

1910 County Road NN
Elkhorn, WI 53121-4454

Phone

(262) 741-3200

Fax

(262) 741-3217

NPI assigned

Oct 13, 2006

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 identifiers 1

Other names 1

• Kelly M Gustavson 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

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 and National Provider Directory roles.

• County of Walworth

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkhorn, WI
  • NPI 1588733307
  Medicare reassignment NPD
• County of Walworth

  • State or Local Public Health Clinic/Center
  • Elkhorn, WI
  • NPI 1548348311
  NPD
• PKM Clinical Solutions LLC

  • Psychologist
  • Muskego, WI
  • NPI 1295202976
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1750471314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1005",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531211005",
            "telephone_number": "262-741-3200",
            "fax_number": "262-741-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 COUNTY ROAD NN",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214454",
            "telephone_number": "262-741-3200",
            "fax_number": "262-741-3217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W206S7867 Pasadena Dr",
            "address_purpose": "LOCATION",
            "city": "Muskego",
            "state": "WI",
            "postal_code": "531509532",
            "country_code": "US",
            "telephone_number": "262-971-5015",
            "fax_number": "855-210-7399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVSON-MATTEK",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2533-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40938700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GUSTAVSON",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chad Michael Greving, D.D.S
• Erica Jean Griffin, PT
• Catherine L Griffith, SAC
• Carolyn A Gualdron, PT
• Laura Guetzkow
• Susan L Guthart, APNP
• Andrea Gutierrez, DDS
• John E Hall
• Jamie Lynn Halleen, DPT
• Tia Handel

• Psychologist in Elkhorn, WI
• Providers in Elkhorn, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.