Individual provider Active NPI

Kaylee Johnson, MSW, LCSW

  • Clinical Social Worker
  • Mount Pleasant, WI
National Provider Identifier
1821655184
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9664-123 Issued in WI
Practice address
5801 Washington Ave Ste 201C
Mount Pleasant, WI 53406-4057
Phone
(262) 909-5674
NPI assigned
May 22, 2019
Last updated
May 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9664-123 WI Primary

Addresses

Primary practice location

5801 Washington Ave Ste 201C
Mount Pleasant, WI 53406-4057

Mailing address

5801 Washington Ave Ste 201C
Mount Pleasant, WI 53406-4057
Phone (262) 909-5674

Other practice location 1

8800 Washington Ave Ste 300
Mount Pleasant, WI 53406-3705
Phone (262) 664-7423

Other practice location 2

1 1/2 W Geneva St
Elkhorn, WI 53121-1722
Phone (262) 723-3424

Other identifiers 1

IdentifierTypeStateIssuer
1821655184MedicaidWI

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

LicenseStateTypeSpecialty
9664-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Positive Regard LLC Clinical CurrentSince May 8, 2022 Accepting new patients
Children's Medical Group PastSince Jul 25, 2019 Accepting new patients
American Behavioral Clinics, SC Past Accepting new patients
Children's Medical Group PastSince Jul 25, 2019 Accepting new patients
Credence Therapy Associates Inc PastSince Aug 1, 2002 Accepting new patients

Locations

5801 Washington Ave
Ste 201C
Mount Pleasant, WI 53406
Phone (262) 900-1768

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1821655184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 WASHINGTON AVE STE 201C",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064057",
            "telephone_number": "262-909-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 WASHINGTON AVE STE 201C",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064057",
            "telephone_number": "262-909-5674"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 Washington Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "534063705",
            "country_code": "US",
            "telephone_number": "262-664-7423",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 1/2 W Geneva St",
            "address_purpose": "LOCATION",
            "city": "Elkhorn",
            "state": "WI",
            "postal_code": "531211722",
            "country_code": "US",
            "telephone_number": "262-723-3424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAYLEE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9664-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821655184",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.