MEDICARE: MICHAEL JAMES WERNER CPRS-S

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	175T00000X	Peer Specialist	APS.000628	OH

General Provider Information

NPI Number	:	1457181091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES WERNER CPRS-S

Provider Business Mailing Address
First Line	:	114 MARION AVE
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1349
Country	:	US
Telephone Number	:	321-626-2057
Fax Number	:

Provider Business Practice Location Address
First Line	:	4317 STATE ROUTE 269 S
Second Line	:
City	:	CASTALIA
State	:	OH
Zip	:	44824-9354
Country	:	US
Telephone Number	:	419-684-9750
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	12/16/2025

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