Active NPI
Jodi Lorene Waddell
- Professional Counselor
- Mauston, WI
National Provider Identifier
1972272755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 12209-125
- Practice address
- 124 Grayside Ave
Mauston, WI 53948-1913 - Phone
- (608) 847-7575
- Fax
- (608) 847-3096
- NPI assigned
- Sep 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 12209-125 | WI | Primary |
Addresses
Primary practice location
124 Grayside Ave
Mauston, WI 53948-1913
Mailing address
S6908 Missel Rd
De Soto, WI 54624-6350
Phone (608) 790-1967
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
124 Grayside Ave
Mauston, WI 53948-1913
Phone (608) 847-7575
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12209-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Valley Integrated Services LLC | Current | Accepting new patients | |
| Pine Valley Residential Services | 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Mauston, WI
- NPI 1013375104
-
- Mental Illness Community Based Residential Treatment Facility
- Mauston, WI
- NPI 1891126751
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1972272755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "S6908 MISSEL RD",
"city": "DE SOTO",
"state": "WI",
"postal_code": "546246350",
"telephone_number": "608-790-1967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 GRAYSIDE AVE",
"city": "MAUSTON",
"state": "WI",
"postal_code": "539481913",
"telephone_number": "608-847-7575",
"fax_number": "608-847-3096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADDELL",
"first_name": "JODI",
"middle_name": "LORENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-07",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "12209-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mauston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.