Active NPI
James D Wiedenhoeft, LCSW
- Clinical Social Worker
- Appleton, WI
National Provider Identifier
1871706507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2781-123
- Practice address
- 1049 N Lynndale Dr
1B
Appleton, WI 54914-3050 - Phone
- (262) 345-5599
- Fax
- (262) 345-5608
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2781-123 | WI | Primary |
Addresses
Primary practice location
1049 N Lynndale Dr
1B
Appleton, WI 54914-3050
Mailing address
W175N11120 Stonewood Dr
Germantown, WI 53022-6511
Phone (262) 345-5560
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2781-123 | Other | WI | LCSW |
| 39-1047224 | Other | WI | TAX ID |
| 39668500 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2781-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin Lutheran Child & Family Service Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1205905908
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1871706507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W175N11120 STONEWOOD DR",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530226511",
"telephone_number": "262-345-5560",
"fax_number": "262-345-5531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1049 N LYNNDALE DR",
"address_2": "1B",
"city": "APPLETON",
"state": "WI",
"postal_code": "549143050",
"telephone_number": "262-345-5599",
"fax_number": "262-345-5608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDENHOEFT",
"first_name": "JAMES",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2781-123",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "2781-123",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "39-1047224",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39668500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.