Individual provider Active NPI

Kristen A Roberts, MSW, LCSW

  • Clinical Social Worker
  • Waukesha, WI
National Provider Identifier
1992287452
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9863-123 Issued in WI
Practice address
N14W23777 Stone Ridge Dr Ste 290
Waukesha, WI 53188-1140
Phone
(414) 667-5809
Fax
(262) 393-2462
NPI assigned
Aug 31, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9863-123 WI Primary

Addresses

Primary practice location

N14W23777 Stone Ridge Dr Ste 290
Waukesha, WI 53188-1140

Mailing address

W229S8170 Big Bend Dr
Big Bend, WI 53103-9671
Phone (262) 271-0231

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
I20220429001416 WI Practitioner - Clinical Social Worker 6709273311 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Empyrean Ventures Inc Clinical CurrentSince Oct 1, 2024 Accepting new patients
Amanda Donath Psychological Services S C CurrentSince May 1, 2026 Accepting new patients
Allergic Diseases SC PastSince Dec 11, 2021 Accepting new patients

Locations

101 W Edison Ave
Ste 246
Appleton, WI 54915
Phone (262) 226-2006

712 Summit Ave
Oconomowoc, WI 53066
Phone (262) 226-2006

N14W23777 Stone Ridge Dr
Ste 290
Waukesha, WI 53188
Phone (262) 716-7580

Organizations & group practices 3

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": "1535673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1992287452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W229S8170 BIG BEND DR",
            "city": "BIG BEND",
            "state": "WI",
            "postal_code": "531039671",
            "telephone_number": "262-271-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N14W23777 STONE RIDGE DR STE 290",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881140",
            "telephone_number": "414-667-5809",
            "fax_number": "262-393-2462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRISTEN",
        "middle_name": "A",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-31",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9863-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.