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NPI Code Detail

MEDICARE: INNER EDGE PSYCHOTHERAPY, LLC

MEDICARE: INNER EDGE PSYCHOTHERAPY, LLC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1700754488
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNER EDGE PSYCHOTHERAPY, LLC
Provider Business Mailing Address
First Line : 316 E SCHILLER ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2020
Country : US
Telephone Number : 414-207-8183
Fax Number :
Provider Business Practice Location Address
First Line : 316 E SCHILLER ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2020
Country : US
Telephone Number : 608-395-9243
Fax Number :
Authorized Official
Title or Position : PSYCHOTHERAPIST
Name : AMY WEIDERT
Credential : MS, LPC
Telephone Number : 414-207-8183
Provider Enumeration Date : 10/25/2025
Last Update Date : 02/08/2026

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