Provider Demographics
NPI:1134898604
Name:FLOERSCH, MICHELLE LAVONNE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAVONNE
Last Name:FLOERSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LAVONNE
Other - Last Name:FLOERSCH CLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W4191 SCHILD RD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-9525
Mailing Address - Country:US
Mailing Address - Phone:608-433-5888
Mailing Address - Fax:
Practice Address - Street 1:124 GRAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1913
Practice Address - Country:US
Practice Address - Phone:608-433-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health