Mardy Juhl

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15486 Issued in WI

Practice address

514 Riverview Ave
Waukesha, WI 53188-3631

Phone

(262) 970-6672

NPI assigned

Jun 25, 2020

Last updated

Jun 25, 2020By the provider in NPPES

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

Other names 1

• Ms. Mardy Ellis Juhl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1861018863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883631",
            "telephone_number": "262-970-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883631",
            "telephone_number": "262-970-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUHL",
        "first_name": "MARDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-25",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15743",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARDY",
            "last_name": "JUHL",
            "middle_name": "ELLIS",
            "prefix": "MS.",
            "credential": "MARDY JUHL GOLDSMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; 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.