Provider Demographics
NPI:1316181431
Name:RISSER, MICHELLE DIONNE (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DIONNE
Last Name:RISSER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E WILSON BRIDGE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2354
Mailing Address - Country:US
Mailing Address - Phone:614-559-1977
Mailing Address - Fax:
Practice Address - Street 1:37 E WILSON BRIDGE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2354
Practice Address - Country:US
Practice Address - Phone:614-559-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 07001281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical