Provider Demographics
NPI:1235914797
Name:WORTHINGTON, MICHELL (BA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELL
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56159 RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1144
Mailing Address - Country:US
Mailing Address - Phone:574-366-2430
Mailing Address - Fax:
Practice Address - Street 1:610 PLUM ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-3057
Practice Address - Country:US
Practice Address - Phone:574-366-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator