Provider Demographics
NPI:1457003089
Name:WALD, MICHELE GRACE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:GRACE
Last Name:WALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVE STE 400W
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2868
Mailing Address - Country:US
Mailing Address - Phone:515-537-2962
Mailing Address - Fax:515-270-4584
Practice Address - Street 1:6200 AURORA AVE STE 400W
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2868
Practice Address - Country:US
Practice Address - Phone:515-537-2962
Practice Address - Fax:515-270-4584
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111154104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker