Russ Kinkade Psy D SC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1296 Issued in WI

Legal business name

RUSS KINKADE PSY D SC

Practice address

6214 Washington Ave
C-10
Mount Pleasant, WI 53406-3986

Phone

(262) 989-5228

Fax

(262) 878-9285

NPI assigned

Jan 27, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Russell William Kinkade Jr., PSY.D.NPI 1033295571

Title

President

Phone

(262) 989-5228

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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

• Russell William Kinkade Jr., PSYD

  • Clinical Psychologist
  • Racine, WI
  • NPI 1033295571
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1992195192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S55W29307 HOLIDAY POINT DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531899026",
            "telephone_number": "262-989-5228",
            "fax_number": "262-878-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6214 WASHINGTON AVE",
            "address_2": "C-10",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063986",
            "telephone_number": "262-989-5228",
            "fax_number": "262-878-9285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "131 E Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Pewaukee",
            "state": "WI",
            "postal_code": "530723471",
            "country_code": "US",
            "telephone_number": "262-989-5228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RUSS KINKADE PSY D SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "KINKADE",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-989-5228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "1296",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David R Ross, MD
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• Jared Roznowski, DPT
• Stephanie L Ruskell, APNP
• Anna Rybak, GNP
• Steven J. Ryder, M.D.
• Joy A Rynda, MD
• Margaret Ann Rynkiewicz
• S.E. Wisconsin Hearing Center Inc.

• Clinic/Center in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.