Samantha Dyson, LPC-IT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7046-226 Issued in WI

Practice address

W62N281 Washington Ave
Cedarburg, WI 53012-2737

Phone

(262) 623-7161

NPI assigned

Jan 4, 2024

Last updated

Jan 4, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kettle Moraine Counseling LLC

  dba Kettle Moraine Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Bend, WI
  • NPI 1568790954
  Medicare reassignment NPD
• Cedarburg Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Cedarburg, WI
  • NPI 1225040926
  NPD
• Affiliated Clinical Services Inc

  • Multi-Specialty Clinic/Center
  • West Bend, WI
  • NPI 1851473698
  NPD (past)

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

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1881464568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W62N281 WASHINGTON AVE",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122737",
            "telephone_number": "262-623-7161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W62N281 WASHINGTON AVE",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122737",
            "telephone_number": "262-623-7161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYSON",
        "first_name": "SAMANTHA",
        "credential": "LPC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-04",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7046-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Doro, MSN, RN, CPNP-AC
• Emily Lynn Dowling, OTR
• Daniel P Duffy, MD
• Kimberly Duran
• Dva Renal Healthcare Inc (Cedarburg Dialysis)
• Linda Ann Edwards Savage, MSW LICSW
• Amanda Lynn Egelseer, OTR
• Greg Ehlers, EDD, LAT
• Ahmed S Elsayed, RPH
• Emopti PN Service Corporation

• Mental Health Counselor in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.