Individual provider Active NPI

Myron Irving Hustad, MSW LCSW ACSW AAMFT

  • Clinical Social Worker
  • Milwaukee, WI
National Provider Identifier
1629159355
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2246123 Issued in WI
Practice address
5000 West National Avenue
Milwaukee, WI 53295
Phone
(414) 384-2000
Fax
(414) 382-5295
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2246123 WI Primary
Marriage & Family Therapist 106H00000X 241124 WI

Addresses

Primary practice location

5000 West National Avenue
Milwaukee, WI 53295

Mailing address

8705 Glencoe Circle
Wauwatosa, WI 53226
Phone (414) 774-6158

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

State licenses

LicenseStateTypeSpecialty
2246123WIMDClinical Social Worker
241124WIMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1629159355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8705 GLENCOE CIRCLE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "53226",
            "telephone_number": "414-774-6158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 WEST NATIONAL AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53295",
            "telephone_number": "414-384-2000",
            "fax_number": "414-382-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSTAD",
        "first_name": "MYRON",
        "middle_name": "IRVING",
        "name_prefix": "Mr.",
        "credential": "MSW LCSW ACSW AAMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2246123",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "241124",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.