Provider Demographics
NPI:1174645204
Name:TURGEON, MICHAEL ALLYN (MS, SW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLYN
Last Name:TURGEON
Suffix:
Gender:M
Credentials:MS, SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 BEASER AVENUE
Mailing Address - Street 2:PO BOX 891
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-682-1160
Mailing Address - Fax:
Practice Address - Street 1:517 BEASER AVENUE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-682-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2786-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174645204OtherNPI