Individual provider Active NPI

Amanda J Knollenberg, LMFT

  • Marriage & Family Therapist
  • Madison, WI
National Provider Identifier
1891199253
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1093 Issued in WI
Practice address
7102 Mineral Point Rd
Madison, WI 53717-1706
Phone
(608) 232-3171
Fax
(608) 262-9246
NPI assigned
Oct 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1093 WI Primary

Addresses

Primary practice location

7102 Mineral Point Rd
Madison, WI 53717-1706

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other names 1

  • Amanda Blimes Other name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240208004447 WI Practitioner - Marriage and Family Therapist 3870936511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Counseling Services IncGroup PAC ID 1456256023, 338 clinicians

Practice addresses (Care Compare)

2901 W Beltline Hwy
Suite 301
Madison, WI 53713-4228
Phone (262) 789-1191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

2901 W Beltline Hwy
Ste 301
Madison, WI 53713
Phone (608) 235-4460

8215 Greenway Blvd
Ste 160
Middleton, WI 53562
Phone (608) 801-4741

1143 Warwick Way
Racine, WI 53406
Phone (262) 321-0110

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.amandaknollenberg@149809.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1891199253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7102 MINERAL POINT RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171706",
            "telephone_number": "608-232-3171",
            "fax_number": "608-262-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOLLENBERG",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BLIMES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.