Individual provider Active NPI

Michael G Washechek, MS LCSW

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1619062833
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4197123 Issued in WI
Practice address
300 Crooks Street
Green Bay, WI 54301
Phone
(920) 436-6800
Fax
(920) 432-5966
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 4197123 WI Primary

Addresses

Primary practice location

300 Crooks Street
Green Bay, WI 54301

Mailing address

PO Box 22308
300 Crooks Street
Green Bay, WI 54305-2308
Phone (920) 436-6800

Other identifiers 2

IdentifierTypeStateIssuer
4199123OtherWIWI DEPT OF REGLODON AND L
39677600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4197123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Services of Northeast Wisconsin Inc Past Accepting new patients
Family Services of Northeast Wisconsin Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619062833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22308",
            "address_2": "300 CROOKS STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052308",
            "telephone_number": "920-436-6800",
            "fax_number": "920-432-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CROOKS STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-436-6800",
            "fax_number": "920-432-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHECHEK",
        "first_name": "MICHAEL",
        "middle_name": "G",
        "credential": "MS LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "4197123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI DEPT OF REGLODON AND L",
            "identifier": "4199123",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39677600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.