Active NPI
Kenneth R Ninham, MSE
- Addiction (Substance Use Disorder) Counselor
- Lac Du Flambeau, WI
National Provider Identifier
1992795223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1060-132
- Practice address
- 129 Old Abe Rd
Lac Du Flambeau, WI 54538-9386 - Phone
- (715) 588-3371
- Fax
- (715) 588-2031
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2624-120 | WI | |
| Professional Counselor | 101YP2500X | 11915-134 | WI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1060-132 | WI | Primary |
Addresses
Primary practice location
129 Old Abe Rd
Lac Du Flambeau, WI 54538-9386
Mailing address
129 Old Abe Rd
Lac Du Flambeau, WI 54538-9386
Phone (715) 588-3371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39231600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1060-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 2624-120 | WI | MD | Mental Health Counselor |
| 11915-134 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466985600000",
"number": "1992795223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 OLD ABE RD",
"city": "LAC DU FLAMBEAU",
"state": "WI",
"postal_code": "545389386",
"telephone_number": "715-588-3371",
"fax_number": "715-588-2031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 OLD ABE RD",
"city": "LAC DU FLAMBEAU",
"state": "WI",
"postal_code": "545389386",
"telephone_number": "715-588-3371",
"fax_number": "715-588-2031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NINHAM",
"first_name": "KENNETH",
"middle_name": "R",
"credential": "MSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2016-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "2624-120",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "11915-134",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1060-132",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39231600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lac Du Flambeau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.