Kristie A Ineichen, PSYD LP
Individual provider Active NPI Clinical Psychologist · Ellsworth, WI
NPI 1871997544 · NPPES record last updated May 1, 2024
Key facts
- NPI
- 1871997544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 4031-57 (WI)
- Practice address
- N5683 530TH St
Ellsworth, WI 54011-5111 - Phone
- (763) 257-4655
- NPI assigned
- Oct 9, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Talkspace Provider Network PA
Practice addresses (Care Compare)
4026 S Burrell St
Milwaukee, WI 53207-4404
Phone (561) 221-5696
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, 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 |
|---|---|---|---|---|
| I20160127000004 | MN | Practitioner - Clinical Psychologist | 8022337385 | Reassigns benefits to 1 organization |
| I20240516001377 | WI | Practitioner - Clinical Psychologist | 8022337385 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Talkspace Provider Network PA | Current |
Accepting new patients | |
| Fraser | Past |
Accepting new patients | |
| Fraser Child and Family Center | Past |
Accepting new patients |
Locations
2578 Broadway
#607
New York, NY 10025
Phone (516) 847-5432
2578 Broadway
Ste 607
New York, NY 10025
Phone (304) 308-3735
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4031-57 | WI | Yes |
| Clinical Psychologist | 103TC0700X | LP5823 | MN |
Addresses
Primary practice location
N5683 530TH St
Ellsworth, WI 54011-5111
Mailing address
N5683 530TH St
Ellsworth, WI 54011-5111
Phone (763) 257-4655
Other providers in Ellsworth, WI
- Anna Fesenmaier
- Mark Clifford Gillen
- Gregory W Bernard DC PA
- Paulette Kay Haus
- Gary S Holden
- Samantha K Johnson
- Carrie Lynn Kern
- Knutson Family Dental
- Kaitlin Knutson
- Lindsey Kocina
All providers in Ellsworth, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 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.