Provider Demographics
NPI:1164076741
Name:MIDDAGH, SHEILA MARIE
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:MIDDAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MARIE
Other - Last Name:THOMSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1210 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2432
Mailing Address - Country:US
Mailing Address - Phone:507-376-4141
Mailing Address - Fax:507-215-7178
Practice Address - Street 1:29566 270TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-6375
Practice Address - Country:US
Practice Address - Phone:605-695-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1081651041C0700X
ME214381041C0700X
ND61141041C0700X
NE27681041C0700X
SD51601041C0700X
MN262081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical