Individual provider Active NPI

Jennifer Conrardy, PSYD

  • Clinical Psychologist
  • Kenosha, WI
National Provider Identifier
1942936539
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4052 Issued in WI
Practice address
2108 63Rd St
Kenosha, WI 53143-4454
Phone
(262) 652-2406
NPI assigned
Jul 27, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4052 WI Primary

Addresses

Primary practice location

2108 63Rd St
Kenosha, WI 53143-4454

Mailing address

6233 39TH Ave # 301
Kenosha, WI 53142-7015
Phone (262) 654-1004

Other names 1

  • Jennifer Craig Former 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
I20220922002036 WI Practitioner - Clinical Psychologist 6608251962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
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)

1317 W Grand Ave
Suite 6
Port Washington, WI 53074-2075
Phone (262) 999-3495

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4052WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Cornerstone Counseling Services, Inc CurrentSince Jan 20, 2026 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

6233 39th Ave
#301
Kenosha, WI 53142

1317 W Grand Ave
Ste 6
Prt Washingtn, WI 53074
Phone (262) 284-8800

1205 S 70th St
Ste 301
West Allis, WI 53214
Phone (414) 475-2788

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": "1658880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1942936539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE # 301",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 63RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434454",
            "telephone_number": "262-652-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRARDY",
        "first_name": "JENNIFER",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "4052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CRAIG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.