Provider Demographics
NPI:1760761712
Name:BEAULIEU, MICHELLE ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:BEAULIEU
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 1:1071 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5859
Mailing Address - Country:US
Mailing Address - Phone:413-695-8006
Mailing Address - Fax:
Practice Address - Street 1:2311 E STADIUM BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4833
Practice Address - Country:US
Practice Address - Phone:734-219-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical