Provider Demographics
NPI:1346598505
Name:RIEMER, MICHELLE LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:RIEMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:WILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5744 BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5202
Mailing Address - Country:US
Mailing Address - Phone:608-630-5440
Mailing Address - Fax:
Practice Address - Street 1:406 N PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1410
Practice Address - Country:US
Practice Address - Phone:608-255-8838
Practice Address - Fax:608-255-8837
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8191-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100026640Medicaid