Carly Wallner

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8355-125 Issued in WI

Practice address

121 W Main St
Port Washington, WI 53074-1813

Phone

(262) 238-8130

NPI assigned

Jun 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of OzaukeeGroup PAC ID 5698737450, 5 clinicians

Practice addresses (Care Compare)

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 Ozaukee

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Washington, WI
  • NPI 1609867001
  Medicare reassignment Care Compare group NPD
• County of Ozaukee

  • Public Health or Welfare Agency
  • Port Washington, WI
  • NPI 1740475250
  NPD

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1801525795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W MAIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W MAIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741813",
            "telephone_number": "262-238-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLNER",
        "first_name": "CARLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "8355-125",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8355-125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anjuli Marie Tuscano, PA-C
• Christie Nicole Usher, MSCF-SLP
• Corrin Elizabeth Van Lanen
• Sophia Barbara Voeltz, LPC-IT
• Kaitlyn Voss, M.D.
• Ciara Wardenburg, DPT
• Rachel Anne Wasielewski
• Mary Larson Weber, P.T.
• Jacqueline Weeden, LCSW
• Elizabeth Noel Wehner

• Mental Health Counselor in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.