Provider Demographics
NPI:1710137963
Name:THOEN, MICHELLE LYNN (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:THOEN
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:THOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-0246
Mailing Address - Country:US
Mailing Address - Phone:612-554-8914
Mailing Address - Fax:715-417-3103
Practice Address - Street 1:307 N CASCADE ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020
Practice Address - Country:US
Practice Address - Phone:612-554-8914
Practice Address - Fax:715-755-2669
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301177101YA0400X
WI3989-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)