Provider Demographics
NPI:1861637316
Name:WINTERSTEIN, MICHELLE BAGAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BAGAN
Last Name:WINTERSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 W HURON ST
Mailing Address - Street 2:APT. 704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3467
Mailing Address - Country:US
Mailing Address - Phone:847-254-9595
Mailing Address - Fax:
Practice Address - Street 1:1308 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3070
Practice Address - Country:US
Practice Address - Phone:847-254-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0152211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical