Provider Demographics
NPI:1356120315
Name:KRIEGER, MICHELLE DAWN (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3153
Mailing Address - Country:US
Mailing Address - Phone:815-347-1406
Mailing Address - Fax:
Practice Address - Street 1:328 N NEIL ST STE C
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3614
Practice Address - Country:US
Practice Address - Phone:217-377-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health