Provider Demographics
NPI:1982219358
Name:SELLS, MICHELLE RENE (LSWAIC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:SELLS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 235TH PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8632
Mailing Address - Country:US
Mailing Address - Phone:360-513-4469
Mailing Address - Fax:
Practice Address - Street 1:326 235TH PL SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8632
Practice Address - Country:US
Practice Address - Phone:360-513-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWIA.SC.609952141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical