MEDICARE: NICHOLAS JON WIESMUELLER LPC

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	101YP2500X	Professional Counselor	11078-125	WI

General Provider Information

NPI Number	:	1841030129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JON WIESMUELLER LPC

Provider Business Mailing Address
First Line	:	936 JENIFER ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3522
Country	:	US
Telephone Number	:	414-554-0163
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 N OAKLAND AVE STE 504
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2265
Country	:	US
Telephone Number	:	414-554-0163
Fax Number	:

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

Provider Enumeration Date	:	05/25/2024
Last Update Date	:	06/10/2026

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