Active NPI
Sheryl Klein-Wassink, CSAC , ICS
- Addiction (Substance Use Disorder) Counselor
- West Bend, WI
National Provider Identifier
1891701447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1993
- Practice address
- 400 W River Dr
West Bend, WI 53090-1567 - Phone
- (262) 338-2717
- Fax
- (262) 338-9767
- NPI assigned
- Aug 1, 2006
- Last updated
- Nov 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1993 | WI | Primary |
Addresses
Primary practice location
400 W River Dr
West Bend, WI 53090-1567
Mailing address
400 W River Dr
West Bend, WI 53090-1567
Phone (262) 338-2717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39368400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affiliated Clinical Services Inc | Past | Accepting new patients | |
| Kettle Moraine Counseling LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- West Bend, WI
- NPI 1851473698
-
dba Kettle Moraine Counseling
- Mental Health Clinic/Center (Including Community Mental Health Center)
- West Bend, WI
- NPI 1568790954
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193875200000",
"number": "1891701447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 W RIVER DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530901567",
"telephone_number": "262-338-2717",
"fax_number": "262-338-9767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 W RIVER DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530901567",
"telephone_number": "262-338-2717",
"fax_number": "262-338-9767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEIN-WASSINK",
"first_name": "SHERYL",
"credential": "CSAC , ICS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2007-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1993",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39368400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.