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Melissa Mari Wiese

Social Worker

Behavioral Health & Social Service Providers

5000 W National Ave, Milwaukee, WI 53295-0001

(414) 384-2000

PECOS Enrollment

Based on the most recent information from CMS, provider Melissa Mari Wiese does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1710159546
Provider Type
Individual
Full Name
Wiese, Melissa Mari
Title
Ms.
Credential
LCSW

Gender
Female
Sole Proprietor
No
Enumeration Date
4/1/2008
Last Updated
4/1/2008

Contact Information

Practice Location

5000 W National Ave, Milwaukee, WI 53295-0001

(414) 384-2000

Unlisted Fax

Mailing Location

5000 W National Ave, Milwaukee, WI 53295-0001

(414) 384-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 7360-123 Wisconsin
Code 101YA0400X	Description Counselor Behavioral Health & Social Service Providers	License 15326-133 Wisconsin

Melissa Mari Wiese

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Slavis, Barry Alan

Waldenberger, Cynthia Ann

Van Thiel, David

De Young, Catherine Veronica

Grzywacz, Bridget Rose

Karrasch-Prenzlow, Linda Marie

Kagabitang, David Wayne

Robinson, David Schuyler

Barnes, Lisa M

Gumm, Joy Lynn