Madonna Lee Kienlen, PEER SPECIALIST

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

2017-004-MM Issued in WY

Practice address

215 Ethete Road
Ft. Washakie, WY 82514

Phone

(307) 335-8374

Fax

(307) 335-8299

NPI assigned

Nov 2, 2017

Last updated

Nov 2, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shoshone & Arapaho Tribal Substance Abuse Court

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Washakie, WY
  • NPI 1881919751
  NPD (past)

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1982116794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 ETHETE ROAD",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "82514",
            "telephone_number": "307-335-8374",
            "fax_number": "307-335-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 ETHETE ROAD",
            "city": "FT. WASHAKIE",
            "state": "WY",
            "postal_code": "82514",
            "telephone_number": "307-335-8374",
            "fax_number": "307-335-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIENLEN",
        "first_name": "MADONNA",
        "middle_name": "LEE",
        "credential": "PEER SPECIALIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-02",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WY",
            "license": "2017-004-MM",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte D Jensen, R.N.
• Gloria Marie Joiner, PHARMACIST
• Jason Adam Jurca, DDS
• Christina Loree Kaper, PTA
• Jan S Keith, COTA
• Amanda Joyce Kinley, MD
• Kasandra Jo Kister, PA-C
• Darlene Lucy Kozlowski
• Cheryl Lynn Lamb-Groves, R.N.
• Alvinita Lamebull, MT

• Peer Specialist in Fort Washakie, WY
• Providers in Fort Washakie, WY by specialty
• Peer Specialist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2017; 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.