Dr Kelly M Gustavson-mattek, PSYD in Elkhorn, WI - Medicare Psychologist Provider

Dr Kelly M Gustavson-mattek, PSYD is a medicare enrolled "Psychologist" provider in Elkhorn, Wisconsin. Her current practice location is 1910 County Road Nn, Elkhorn, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (262) 741-3200.

Dr Kelly M Gustavson-mattek is licensed to practice in Wisconsin (license number 2533-057) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1750471314.

Contact Information

	Dr Kelly M Gustavson-mattek, PSYD
	1910 County Road Nn, Elkhorn, WI 53121-4454
	(262) 741-3200
	(262) 741-3217

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Kelly M Gustavson-mattek
Gender	Female
Speciality	Psychologist
Location	1910 County Road Nn, Elkhorn, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1750471314
Provider Enumeration Date: 10/13/2006
Last Update Date: 05/05/2025

Medicare PECOS Information:

PECOS PAC ID: 6901806769
Enrollment ID: I20070102000256

Medical Identifiers

Medical identifiers for Dr Kelly M Gustavson-mattek such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1750471314	NPI	-	NPPES
40938700	Medicaid	WI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	2533-057 (Wisconsin)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kelly M Gustavson-mattek allows following entities to bill medicare on her behalf.

Entity Name	County Of Walworth
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1588733307 PECOS PAC ID: 6002872835 Enrollment ID: O20041203000437

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly M Gustavson-mattek is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Kelly M Gustavson-mattek, PSYD Po Box 1005, Elkhorn, WI 53121-1005 Ph: (262) 741-3200	Dr Kelly M Gustavson-mattek, PSYD 1910 County Road Nn, Elkhorn, WI 53121-4454 Ph: (262) 741-3200

Reviews and Comments

Psychologist in Elkhorn, WI

Mrs. Vicki Ann Wahler, LPC Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1 1/2 W Geneva St, Credence Therapy Associates, Elkhorn, WI 53121 Phone: 262-723-3424 Fax: 262-723-8308
Lura M. Asby, PSY.D Psychologist Medicare: Accepting Medicare Assignments Practice Location: 797 E Geneva St, Elkhorn, WI 53121 Phone: 262-723-1455
Victoria S Loudon, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1 1/2 W Geneva St, Elkhorn, WI 53121 Phone: 262-723-3424

Dr Kelly M Gustavson-mattek, PSYD - Medicare Psychologist in Elkhorn, WI