Provider Demographics
NPI:1093964561
Name:BATTIN, MICHELLE MARIE CANI (BA, MA, PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE CANI
Last Name:BATTIN
Suffix:
Gender:F
Credentials:BA, MA, PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:CANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MA, PHD
Mailing Address - Street 1:400 NW GILMAN BLVD UNIT 571
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0292
Mailing Address - Country:US
Mailing Address - Phone:626-344-0634
Mailing Address - Fax:
Practice Address - Street 1:8290 165TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3948
Practice Address - Country:US
Practice Address - Phone:425-869-2644
Practice Address - Fax:425-867-0930
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26203103TC0700X
WAPY60655194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDICAL