Active NPI
Elaine Catherine Kluth, LCSW
- Clinical Social Worker
- Green Bay, WI
National Provider Identifier
1750476990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7039123
- Practice address
- 3263 Eaton Rd
Green Bay, WI 54311-6830 - Phone
- (920) 433-6700
- Fax
- (920) 433-6738
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7039123 | WI | Primary |
Addresses
Primary practice location
3263 Eaton Rd
Green Bay, WI 54311-6830
Mailing address
PO Box 22040
Green Bay, WI 54305-2040
Phone (920) 445-7226
Other practice location 1
831 Parker Ave
Algoma, WI 54201-1808
Phone (920) 487-3676
Other practice location 2
820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40939700 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7039123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Services of Northeast Wisconsin Inc | Past | Accepting new patients | |
| Family Services of Northeast Wisconsin Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Menasha, WI
- NPI 1275525925
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Green Bay, WI
- NPI 1467453167
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653955200000",
"number": "1750476990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22040",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543052040",
"telephone_number": "920-445-7226",
"fax_number": "920-445-7289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3263 EATON RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116830",
"telephone_number": "920-433-6700",
"fax_number": "920-433-6738"
}
],
"practiceLocations": [
{
"address_1": "831 Parker Ave",
"address_purpose": "LOCATION",
"city": "Algoma",
"state": "WI",
"postal_code": "542011808",
"country_code": "US",
"telephone_number": "920-487-3676",
"fax_number": "920-437-0533",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "820 Arbutus Ave",
"address_purpose": "LOCATION",
"city": "Oconto",
"state": "WI",
"postal_code": "541532004",
"country_code": "US",
"telephone_number": "920-835-5500",
"fax_number": "920-445-7289",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLUTH",
"first_name": "ELAINE",
"middle_name": "CATHERINE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2022-05-31",
"certification_date": "2022-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7039123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40939700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.