MEDICARE: MR. MICHAEL JAMES WEIDMAN II MSW, LCSW, SAC-IT

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	1041C0700X	Clinical Social Worker	8211-123	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16604-130	WI

General Provider Information

NPI Number	:	1467714428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JAMES WEIDMAN II MSW, LCSW, SAC-IT

Provider Business Mailing Address
First Line	:	N113W13341 CRESTVIEW DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-3610
Country	:	US
Telephone Number	:	414-519-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST STE 1300
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5636
Country	:	US
Telephone Number	:	414-358-7144
Fax Number	:	414-358-7158

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

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	01/17/2026

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