KELLY THOMACK (NPI# 1750796488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750796488 |
| Entity Type | Individual |
| Full Name | KELLY THOMACK |
| Practice Address |
5471 W Waterford Ln Appleton WI 54913-8510 |
| Mailing Address |
5337 W Grande Market Dr Appleton WI 54913-8442 |
| Practice Telephone | 9207317445 |
| Practice Fax Number | 9207317490 |
| Mailing Telephone | 9207317445 |
| Mailing Fax Number | 9208822946 |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2019-05-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
5455-125 | WI | Behavioral Health & Social Service Providers |
| Street Address |
5471 W WATERFORD LN |
| City | APPLETON |
| State | WI |
| Zip Code | 54913-8510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215921127 | Karen W Beutler | Family Medicine | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2005-09-07 |
| 1235634510 | Kristin Knott | Radiology | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2018-03-28 |
| 1013362631 | Brittany Goodrich-braun | Family Medicine | 5471 W Waterford Ln, Appleton, WI 54913 | 2016-05-02 |
| 1730452400 | Susan Haydar | Psychologist | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2012-02-10 |
| 1902002371 | Kristal Kay Wichman | Social Worker | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2007-06-22 |
| 1558423517 | Joanne M Stephany | Nurse Practitioner | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2006-12-15 |
| 1558308577 | Iris N Torres | Family Medicine | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2006-05-31 |
| 1962496760 | Jose M Leiva | Family Medicine | 5471 W Waterford Ln, Appleton, WI 54913-8510 | 2005-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083236178 | Katherine Kirchner | Counselor | 1636 W Homestead Dr, Appleton, WI 54914-2026 | 2020-05-11 |
| 1679114136 | Trever Jaymes Allcock | Counselor | 711 N Lynndale Dr, Appleton, WI 54914-3078 | 2019-10-04 |
| 1780232231 | Mark Andrew Wilkerson | Counselor | 446 N Westhill Blvd Ste 6, Appleton, WI 54914-6533 | 2019-08-28 |
| 1013563030 | Nhia Moua | Counselor | 5601 W Grande Market Dr Ste N, Appleton, WI 54913-8511 | 2019-08-15 |
| 1457819419 | Charisma L Deyo-sonntag | Counselor | 1047 N Lynndale Dr Ste 2b, Appleton, WI 54914-3059 | 2019-03-08 |
| 1639643802 | Julie Ann Prudom | Counselor | 524 W Wayfarer Ct, Appleton, WI 54913-6865 | 2019-01-21 |
| 1588130827 | Joann Marie Miller | Counselor | 5601 W Grande Market Dr Ste A1, Appleton, WI 54913-8506 | 2018-10-14 |
| 1003301870 | Walk By Faith Counseling, LLC | Counselor | W6268 Spencer Rd, Appleton, WI 54914-7528 | 2018-06-25 |
| 1699269241 | Deanna Sieg | Counselor | 1920 N Casaloma Dr, Appleton, WI 54913-7982 | 2018-06-18 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| Find all providers in APPLETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.