Provider Demographics
NPI:1750492047
Name:PAZDAN, MICHAEL G (LCSW MSSW CSAC ICS S)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:PAZDAN
Suffix:
Gender:M
Credentials:LCSW MSSW CSAC ICS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 W CAPITOL DR FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:414-874-6288
Mailing Address - Fax:414-874-6291
Practice Address - Street 1:13950 W CAPITOL DR FL 2
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:414-874-6288
Practice Address - Fax:414-874-6291
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI180-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39230400Medicaid