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NPI Code Detail

MEDICARE: MICHAELA WIERSMA

MEDICARE: MICHAELA WIERSMA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1083566939
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAELA WIERSMA
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number : 949-357-2556
Fax Number : 949-357-2556
Provider Business Practice Location Address
First Line : 7777 BONHOMME AVE STE 1800
Second Line :
City : CLAYTON
State : MO
Zip : 63105-1931
Country : US
Telephone Number : 636-202-0693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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Directions to “ MICHAELA WIERSMA ” Practice Location

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