Amanda K Kalisz, MSW
Individual provider Active NPI Clinical Social Worker · Sparta, WI
NPI 1831595859 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1831595859
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 8095 (WI)
- Practice address
- 1111 W Wisconsin St
Sparta, WI 54656-2233 - Phone
- (608) 269-6731
- NPI assigned
- Nov 19, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Gundersen Clinic LTD
Practice addresses (Care Compare)
1111 W Wisconsin St
Sparta, WI 54656-2233
Phone (608) 269-6731
402 A W Lake St
Friendship, WI 53934-9699
Phone (608) 339-8471
402 W Lake St
Friendship, WI 53934-9699
Phone (608) 339-3331
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150126002272 | WI | Practitioner - Clinical Social Worker | 4082938824 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29548 | MN | MD | Clinical Social Worker |
| 8095 | WI | MD | Clinical Social Worker |
| 15622 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Lutheran Express Care, Inc | Current |
Accepting new patients | |
| Gundersen Clinic LTD | Current |
Accepting new patients |
Locations
402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681
1111 W Wisconsin St
Sparta, WI 54656
Phone (608) 263-9531
601 N Superior Ave
Tomah, WI 54660
Phone (608) 374-3853
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 15622 | WI | |
| Clinical Social Worker | 1041C0700X | 29548 | MN | |
| Clinical Social Worker | 1041C0700X | 8095 | WI | Yes |
Addresses
Primary practice location
1111 W Wisconsin St
Sparta, WI 54656-2233
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other providers in Sparta, WI
- Emily Jerome
- Alicia Johnson
- Jenna Johnson
- Jennifer Johnson
- Jessalyn Ilene Johnson
- Ethan Karls
- Megan Karls
- Myrna M Kasten
- William Pierce Keane
- Heather Marie Kehren
All providers in Sparta, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.