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NPI Code Detail

MEDICARE: MR. MICHAEL CHARLES WEYAND MSW, LICSW, LCSW,

MEDICARE: MR. MICHAEL CHARLES WEYAND MSW, LICSW, 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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP00004960WA
21041C0700XClinical Social WorkerLW00007884WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871586222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL CHARLES WEYAND MSW, LICSW, LCSW,
Provider Business Mailing Address
First Line : 1601 E 4TH PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98661-3753
Country : US
Telephone Number : 360-624-2744
Fax Number :
Provider Business Practice Location Address
First Line : 6926 NE FOURTH PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98661-7254
Country : US
Telephone Number : 609-933-3000
Fax Number : 360-993-3099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 05/06/2025

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