Provider Demographics
NPI:1861622789
Name:WIEME, MICHELLE SUZANNE (MS, LIMHP, NCC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:WIEME
Suffix:
Gender:F
Credentials:MS, LIMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15964 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1905
Mailing Address - Country:US
Mailing Address - Phone:712-310-7530
Mailing Address - Fax:
Practice Address - Street 1:12165 W CENTER RD
Practice Address - Street 2:SUITE #58
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3962
Practice Address - Country:US
Practice Address - Phone:402-661-4149
Practice Address - Fax:402-614-5227
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025994300Medicaid