Melissa Wichterman

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401012129 Issued in MI

Practice address

2828 Kraft Ave SE Ste 186
Grand Rapids, MI 49512-2076

Phone

(616) 949-9550

Fax

(616) 949-9551

NPI assigned

Jun 5, 2013

Last updated

Dec 18, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Medicare enrollment (NPD)

Enrolled

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

• Centennial Park Counseling, PLLC

  • Social Worker
  • Grand Rapids, MI
  • NPI 1689814469
  Medicare reassignment

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1467890152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 KRAFT AVE SE STE 186",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122076",
            "telephone_number": "616-949-9550",
            "fax_number": "269-979-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 KRAFT AVE SE STE 186",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122076",
            "telephone_number": "616-949-9550",
            "fax_number": "616-949-9551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICHTERMAN",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401012129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "6401012129",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alanna Joy Wiarda, M.D.
• Gabrielle Wiarda, LMSW
• Hannah Wichern, MPH
• Carolyn Wichlacz, P.T.
• Robert Wichlacz, MPT
• Carrie Elizabeth Wicklund, LMSW
• Daniel Francis Wicklund, DNP
• Benjamin Paul Wickman
• Andrew Benjamin Wicks, PT, DPT
• Laura Meeker Wicksall, LMSW

• Mental Health Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.