Individual provider Active NPI

Linda Jeanne Martenet, LPC IT

  • Professional Counselor
  • West Bend, WI
National Provider Identifier
1992297568
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3872-226 Issued in WI
Practice address
400 W River Dr
West Bend, WI 53090-1518
Phone
(262) 334-4340
Fax
(262) 334-4341
NPI assigned
May 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 7612-125 WI
Professional Counselor 101YP2500X 3872-226 WI Primary

Addresses

Primary practice location

400 W River Dr
West Bend, WI 53090-1518

Mailing address

1122 Hickory St Apt 6
Grafton, WI 53024-1134
Phone (262) 808-6525

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
I20240329001004 WI Practitioner - Mental Health Counselor 3779921507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Group practices
Kettle Moraine Counseling LLCGroup PAC ID 8527353747, 20 clinicians

Practice addresses (Care Compare)

400 W River Dr
West Bend, WI 53090-1518
Phone 262334434013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3872-226WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kettle Moraine Counseling LLC CurrentSince Mar 16, 2024 Accepting new patients
Affiliated Clinical Services Inc PastSince Dec 22, 2019 Accepting new patients

Locations

400 W River Dr
West Bend, WI 53090
Phone (262) 334-4340

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": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1992297568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 HICKORY ST APT 6",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530241134",
            "telephone_number": "262-808-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W RIVER DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530901518",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTENET",
        "first_name": "LINDA",
        "middle_name": "JEANNE",
        "credential": "LPC IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-30",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "7612-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3872-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.