Provider Demographics
NPI:1487681474
Name:SCHMID-EGLESTON, MICHELLE A (MA LP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:SCHMID-EGLESTON
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2756
Mailing Address - Country:US
Mailing Address - Phone:507-301-3412
Mailing Address - Fax:507-301-3308
Practice Address - Street 1:8401 WAYZATA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1379
Practice Address - Country:US
Practice Address - Phone:762-544-1006
Practice Address - Fax:763-544-1008
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist