Michelle R. Witt, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149-012361 Issued in IL

Practice address

210 Burns Farm Blvd N
Edwardsville, IL 62025-2498

Phone

(618) 401-3825

NPI assigned

Apr 12, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Witt and Wisdom Counseling PLLC

  • Clinical Social Worker
  • Edwardsville, IL
  • NPI 1669227773
  NPD Authorized official
• Illinois Baptist Children'S Home and Family Services

  • Community/Behavioral Health Agency
  • Carmi, IL
  • NPI 1275682551
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609027200000",
    "number": "1902020944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 BURNS FARM BLVD N",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252498",
            "telephone_number": "184-013-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 BURNS FARM BLVD N",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252498",
            "telephone_number": "618-401-3825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "MICHELLE",
        "middle_name": "R.",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-12-27",
        "certification_date": "2020-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-012361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "149-012361",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wilson Standard Wellness
• Destiney Wilson
• Kaitlyn Wilson
• Avonna K Wise, RN
• Witt and Wisdom Counseling PLLC
• Rachel Witt
• Brent Douglas Wohlford, D.M.D.
• Diane Gail Wolfe, SLP
• Courtney Nicole Woll, COTA/L
• Emily G Woodell, RBT

• Clinical Social Worker in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2020; 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.