Provider Demographics
NPI:1578127247
Name:ATTERBURY, MICHELLE CATHLEA (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CATHLEA
Last Name:ATTERBURY
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53804-9650
Mailing Address - Country:US
Mailing Address - Phone:608-379-3373
Mailing Address - Fax:
Practice Address - Street 1:1160 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1746
Practice Address - Country:US
Practice Address - Phone:608-822-5052
Practice Address - Fax:608-822-0131
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101051041C0700X
WI131356-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30762Medicaid