Provider Demographics
NPI:1629269907
Name:REXSES, MICHELLE LEE (SST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:REXSES
Suffix:
Gender:F
Credentials:SST
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:REXSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SST
Mailing Address - Street 1:715 PYLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4456
Mailing Address - Country:US
Mailing Address - Phone:906-779-0549
Mailing Address - Fax:906-774-1570
Practice Address - Street 1:715 PYLE DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4456
Practice Address - Country:US
Practice Address - Phone:906-779-0549
Practice Address - Fax:906-774-1570
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803058440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker