Individual provider Active NPI

Lynn Marie Dusold, MSW, LCSW

  • Clinical Social Worker
  • Brookfield, WI
National Provider Identifier
1891836854
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2800-123 Issued in WI
Practice address
13105 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8022
Phone
(262) 641-9790
Fax
(262) 641-9791
NPI assigned
Feb 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2800-123 WI Primary

Addresses

Primary practice location

13105 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8022

Mailing address

11121 W Oklahoma Ave
West Allis, WI 53227-4033
Phone (262) 641-9790

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
I20220429001327 WI Practitioner - Clinical Social Worker 0345561692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathways Counseling Center II LLCGroup PAC ID 7315970969, 9 clinicians

Practice addresses (Care Compare)

11121 W Oklahoma Ave
West Allis, WI 53227-4033
Phone (262) 641-9790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2800-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Counseling Center II LLC CurrentSince Apr 1, 2022 Accepting new patients
Allergic Diseases SC PastSince Apr 1, 2022 Accepting new patients

Locations

13105 W Bluemound Rd
Ste 100
Brookfield, WI 53005
Phone (262) 641-9790

11121 W Oklahoma Ave
West Allis, WI 53227
Phone (262) 641-9790

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1891836854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11121 W OKLAHOMA AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532274033",
            "telephone_number": "262-641-9790",
            "fax_number": "262-641-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13105 W BLUEMOUND RD",
            "address_2": "SUITE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530058022",
            "telephone_number": "262-641-9790",
            "fax_number": "262-641-9791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSOLD",
        "first_name": "LYNN",
        "middle_name": "MARIE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-10",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2800-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.