Provider Demographics
NPI:1245330307
Name:BINGEN, MICHELLE LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:BINGEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:KUZULKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:279 S 17TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3001
Mailing Address - Country:US
Mailing Address - Phone:262-306-8994
Mailing Address - Fax:262-306-9317
Practice Address - Street 1:279 S 17TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3001
Practice Address - Country:US
Practice Address - Phone:262-306-8994
Practice Address - Fax:262-306-9317
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI646123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker