KELLEY SUSAN WIESE (MSW) – Clinical Social Worker, NPI 1194385633

KELLEY SUSAN WIESE (MSW) is a healthcare provider. based in Midland, Michigan. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials MSW. They hold a License No. 6801103963 (MI). The NPI Number for KELLEY SUSAN WIESE (MSW) is 1194385633

Main info

Female
Sole Proprietor
34 Years Of Experience
Accepts Medicare Assignment
Name
KELLEY SUSAN WIESE (MSW)
NPI
1194385633
Phone
Not provided
Address
612 CORVUS DR
Enumeration Date
17 June 2019
Last Update Date
17 June 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9894269295
Graduation Year
1992 (34 years ago)
PAC ID
1557728094
Group Practice PAC ID
4688660533
Professional Enrollment ID
I20230527000188
Address ID
MI486242215GL655XXAVEX400
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:6State licenses:1Digital endpointsOther names

4,820 CLINICAL SOCIAL WORKER in MI

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Provider Addresses for KELLEY SUSAN WIESE (MSW)

  • Corvus Dr, Midland, Midland County, Michigan, 48640-2934, United States

    MIDLAND, MI 486428111

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-05-27

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230527000188IClinical Social WorkerMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48642)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4688660533View full group profile

Reviews

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Frequently asked questions

What is KELLEY SUSAN WIESE (MSW)'s NPI number?
KELLEY SUSAN WIESE (MSW)'s NPI is 1194385633 — the number used across U.S. healthcare to identify this provider.
Active or inactive — what applies to KELLEY SUSAN WIESE (MSW)?
You should see KELLEY SUSAN WIESE (MSW) as active in CMS-hosted NPPES data.
What expertise is attributed to KELLEY SUSAN WIESE (MSW)?
KELLEY SUSAN WIESE (MSW)'s specialty line reads Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where in Michigan is KELLEY SUSAN WIESE (MSW) registered?
Use Midland, Michigan as the headline location for KELLEY SUSAN WIESE (MSW) here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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