NPIMap

Organization Active NPI

Kennedy'S Circle of Wellness LLC

  • Mental Health Counselor
  • Milwaukee, WI
National Provider Identifier
1942856091
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
KENNEDY'S CIRCLE OF WELLNESS LLC
Practice address
3614 W North Ave
Milwaukee, WI 53208-1416
Phone
(414) 399-8736
NPI assigned
Aug 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

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

Authorized official

Name
Shajuan KennedyNPI 1861973083
Title
Director
Phone
(414) 399-8736

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3614 W North Ave
Milwaukee, WI 53208-1416

Mailing address

3614 W North Ave
Milwaukee, WI 53208-1416
Phone (414) 346-0276

Other practice location 1

13035 W Bluemound Rd
Brookfield, WI 53005-8001
Phone (262) 244-0729

National Provider Directory

National Provider Directory

Locations

13035 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 223-6125

3614 W North Ave
Milwaukee, WI 53208
Phone (414) 346-0276

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1942856091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 W NORTH AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081416",
            "telephone_number": "414-346-0276",
            "fax_number": "414-600-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3614 W NORTH AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081416",
            "telephone_number": "414-399-8736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13035 W Bluemound Rd",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "WI",
            "postal_code": "530058001",
            "country_code": "US",
            "telephone_number": "262-244-0729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENNEDY'S CIRCLE OF WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "SHAJUAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "414-399-8736"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.