MEDICARE: CHRISTINE WIESE LPC-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	101YP2500X	Professional Counselor	8894	WI

General Provider Information

NPI Number	:	1851249627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE WIESE LPC-IT

Provider Business Mailing Address
First Line	:	4906 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2325
Country	:	US
Telephone Number	:	414-449-4777
Fax Number	:	414-270-2971

Provider Business Practice Location Address
First Line	:	4906 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2325
Country	:	US
Telephone Number	:	414-449-4777
Fax Number	:	414-270-2971

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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