Provider Demographics
NPI:1518486075
Name:WIEBERG, MICHAEL (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WIEBERG
Suffix:
Gender:M
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 FLINTROCK ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-9408
Mailing Address - Country:US
Mailing Address - Phone:816-304-6215
Mailing Address - Fax:
Practice Address - Street 1:7199 W 98TH TER STE 130
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-6158
Practice Address - Country:US
Practice Address - Phone:913-294-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020805104100000X
MO20180129291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker