Provider Demographics
NPI:1639110265
Name:ENGLAND, MICHELLE R (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305S1ENOtherMNBS #
MN25442OtherNDBS #
MNHP53176OtherHEALTHPARTNERS #
MN19140Medicaid
MN410085900Medicaid
MN1639110265Medicaid
MN6269317OtherMEDICA #
MNDA9031045287OtherPREFERRED ONE #
MN2360601OtherAMERICA'S PPO/ARAZ #
MN1639110265Medicaid
MN800001975Medicare PIN