Provider Demographics
NPI:1689970642
Name:WIEGAND, MICHELLE LYNN
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:KOEPSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP, PMSW
Mailing Address - Street 1:705 E. 41ST ST., STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6048
Mailing Address - Country:US
Mailing Address - Phone:605-444-7643
Mailing Address - Fax:605-444-7690
Practice Address - Street 1:705 E. 41ST ST., STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6048
Practice Address - Country:US
Practice Address - Phone:605-444-7643
Practice Address - Fax:605-444-7690
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3264104100000X
NE8407104100000X
NE6583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker