Healthcare Provider Details

I. General information

NPI: 1346393287
Provider Name (Legal Business Name): MICHAEL H WINIUS MSW , LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 S NICOLET ROAD
APPLETON ID
54914-8270
US

IV. Provider business mailing address

477 S NICOLET ROAD
APPLETON ID
54914-8270
US

V. Phone/Fax

Practice location:
  • Phone: 920-882-6610
  • Fax: 920-882-6611
Mailing address:
  • Phone: 920-882-6610
  • Fax: 920-882-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6699 123
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier40920800
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: