Christine Wielgos, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

110849 Issued in TX

Practice address

11518 N Port Washington Rd Ste 202
Mequon, WI 53092-3443

Phone

(262) 244-6177

Fax

(262) 299-3040

NPI assigned

Oct 1, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.christinewielgos@149809.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornerstone Counseling Services, Inc

  • Mental Health Counselor
  • Brookfield, WI
  • NPI 1033127246
  Medicare reassignment NPD
• Progressive Behavioral Health, PLLC

  • Mental Health Counselor
  • Friendswood, TX
  • NPI 1659567238
  Medicare reassignment NPD
• Willis Health Agency Inc.

  • Home Health Agency
  • Chicago, IL
  • NPI 1619612165
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1114278157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W GLEN OAKS LN STE 110",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923392",
            "telephone_number": "262-244-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11518 N PORT WASHINGTON RD STE 202",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923443",
            "telephone_number": "262-244-6177",
            "fax_number": "262-299-3040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1448 N Milwaukee Ave",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606229225",
            "country_code": "US",
            "telephone_number": "312-476-9064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIELGOS",
        "first_name": "CHRISTINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2023-09-05",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019033",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9464-123",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "110849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100110201",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Jensen Wheeler, DPT
• Bonnie L. White, MA, SAC-IT
• Wholehearted Integrative Bodymind Therapies LLC
• Mary Beth Wick, O.T.R.
• Laila Wiechmann
• Nancy Wiener, PT
• Emily Wilde
• Wildstone Wellness, LLC
• Alexandra Dutton Wilk, LCSW
• Aubrey Wilke

• Clinical Social Worker in Mequon, WI
• Providers in Mequon, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.