NPIMap

Organization Active NPI

Safe Harbor Health, LLC

  • Clinical Social Worker
  • Verona, WI
National Provider Identifier
1861079816
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SAFE HARBOR HEALTH, LLC
Practice address
524 W Verona Ave Ste 105
Verona, WI 53593-1443
Phone
(608) 845-2081
NPI assigned
Mar 25, 2021
Last updated
Feb 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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

Authorized official

Name
Jaclyn Sue SlesarevaNPI 1336616523
Title
Director
Phone
(608) 845-2081

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

524 W Verona Ave Ste 105
Verona, WI 53593-1443

Mailing address

524 W Verona Ave Ste 105
Verona, WI 53593-1443
Phone (608) 845-2081

Other identifiers 1

IdentifierTypeStateIssuer
100093506MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408002010 WI Part B Supplier - Clinic/Group Practice 1052729159 Receives reassigned benefits from 7 practitioners
Practice locations: Verona, WI

National Provider Directory

National Provider Directory

Locations

524 W Verona Ave
Ste 105
Verona, WI 53593
Phone (608) 845-2081

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1861079816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 W VERONA AVE STE 105",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535931443",
            "telephone_number": "608-845-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 W VERONA AVE STE 105",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535931443",
            "telephone_number": "608-845-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-25",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "SLESAREVA",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "608-845-2081"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100093506",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Verona, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.