Provider Demographics
NPI:1386004968
Name:FERREL, MICHELLE NICOLE (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:FERREL
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1547
Mailing Address - Country:US
Mailing Address - Phone:612-746-3552
Mailing Address - Fax:
Practice Address - Street 1:570 ASBURY ST STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1851
Practice Address - Country:US
Practice Address - Phone:651-644-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1386004968Medicaid