Provider Demographics
NPI:1235847039
Name:STANGL, MICHELLE J (LADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:STANGL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYMOND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1700
Mailing Address - Country:US
Mailing Address - Phone:612-699-7776
Mailing Address - Fax:
Practice Address - Street 1:700 RAYMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1700
Practice Address - Country:US
Practice Address - Phone:612-699-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)