Healthcare Provider Details

I. General information

NPI: 1699156075
Provider Name (Legal Business Name): MICHAEL R REDDIN MS, LPC, SAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

IV. Provider business mailing address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

V. Phone/Fax

Practice location:
  • Phone: 608-274-0355
  • Fax:
Mailing address:
  • Phone: 608-274-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6308-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16325-131
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: