Provider Demographics
NPI:1669670766
Name:STRONACH, MICHELLE DENISE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:STRONACH
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 1:2002 LONDON ROAD
Mailing Address - Street 2:SUITE 93B
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-2150
Mailing Address - Country:US
Mailing Address - Phone:715-817-2279
Mailing Address - Fax:715-834-7563
Practice Address - Street 1:2002 LONDON ROAD
Practice Address - Street 2:SUITE 93B
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-2150
Practice Address - Country:US
Practice Address - Phone:715-817-2279
Practice Address - Fax:715-394-9182
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1914-1231041C0700X
MN18891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39254900Medicaid