Provider Demographics
NPI:1497466908
Name:MIDDLETON, MICHELLE L (LICSW;MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LICSW;MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE BASIL CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2308
Mailing Address - Country:US
Mailing Address - Phone:360-519-4072
Mailing Address - Fax:
Practice Address - Street 1:2201 SE BASIL CT
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2308
Practice Address - Country:US
Practice Address - Phone:360-519-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608903991041C0700X
WALW614059591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical