Provider Demographics
NPI:1760859490
Name:GLEASON, MICHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 N. 1ST ST, SUITE 5000
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4727
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:
Practice Address - Street 1:731 N. 1ST ST, SUITE 5000
Practice Address - Street 2:OPTIONAL
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4727
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8337-123101YA0400X
WI83371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty