Provider Demographics
NPI:1891059515
Name:MCGLADE, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCGLADE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 CENTRE POINTE CURV
Mailing Address - Street 2:SUITE 375
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1350
Mailing Address - Country:US
Mailing Address - Phone:651-686-0440
Mailing Address - Fax:651-452-1189
Practice Address - Street 1:1200 CENTRE POINTE CURV
Practice Address - Street 2:SUITE 375
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1350
Practice Address - Country:US
Practice Address - Phone:651-686-0440
Practice Address - Fax:651-452-1189
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist