Provider Demographics
NPI:1760179766
Name:MICHAUD, TIFFANY D (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20360 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-9147
Mailing Address - Country:US
Mailing Address - Phone:715-579-7550
Mailing Address - Fax:
Practice Address - Street 1:925 W RIVER ST STE 7
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2188
Practice Address - Country:US
Practice Address - Phone:715-579-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7098-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional