Provider Demographics
NPI:1518580182
Name:PERRON, MICHELE DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DENISE
Last Name:PERRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-1735
Mailing Address - Country:US
Mailing Address - Phone:218-591-5018
Mailing Address - Fax:
Practice Address - Street 1:912 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-1735
Practice Address - Country:US
Practice Address - Phone:218-591-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16265-132101YA0400X
MI2-01642101YA0400X
MN302718101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)