Provider Demographics
NPI:1053866095
Name:MICHELLE TRUDELL, PLLC
Entity Type:Organization
Organization Name:MICHELLE TRUDELL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:989-574-5122
Mailing Address - Street 1:4771 2 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2775
Mailing Address - Country:US
Mailing Address - Phone:989-778-2323
Mailing Address - Fax:989-778-2322
Practice Address - Street 1:4771 2 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2775
Practice Address - Country:US
Practice Address - Phone:989-778-2323
Practice Address - Fax:989-778-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010877181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty