Provider Demographics
NPI:1902205719
Name:WILKIE, MICHELE ANNE
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNE
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 O RD # 7
Mailing Address - Street 2:
Mailing Address - City:MACK
Mailing Address - State:CO
Mailing Address - Zip Code:81525-5001
Mailing Address - Country:US
Mailing Address - Phone:970-250-5134
Mailing Address - Fax:
Practice Address - Street 1:215 RICE ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5818
Practice Address - Country:US
Practice Address - Phone:970-712-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COACD.0001868101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health