MEDICARE: ELLEN WIEGER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	254729	KY

General Provider Information

NPI Number	:	1356702377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN WIEGER LCSW

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PROSPEROUS PL STE 201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1866
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	06/09/2026

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