Provider Demographics
NPI:1477003861
Name:BATES-LEON, MICHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BATES-LEON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2742
Mailing Address - Country:US
Mailing Address - Phone:219-805-9982
Mailing Address - Fax:
Practice Address - Street 1:2001 W 19TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-2742
Practice Address - Country:US
Practice Address - Phone:219-805-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker