VIRGINIA V FENNEMA MSW LCSW NPI 1376560946

NPI Information

NPI: 1376560946
Provider Name: VIRGINIA V FENNEMA, MSW, LCSW
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

PECOS Registration: Yes

Address:
6121 GREEN BAY RD
SUITE 220
KENOSHA, WI
ZIP 53142
Phone: (262) 652-7222
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Virginia V Fennema, MSW, LCSW is a mental health counselor in Kenosha, WI. Virginia V Fennema, MSW, LCSW NPI is 1376560946. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6121 GREEN BAY RD
SUITE 220
KENOSHA, WI
ZIP 53142-926
Phone: (262) 652-7222
Fax: (262) 652-1734

The NPI 1376560946 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 7/17/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	1507-123	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	39296200	MEDICAID	WISCONSIN
2	467366	OTHER	WISCONSIN	PHCS
3	175724	OTHER	WISCONSIN	VALUE OPTIONS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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