Provider Demographics
NPI:1356162861
Name:DODDEMA, MICHELE NICOLE (CSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:NICOLE
Last Name:DODDEMA
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:NICOLE
Other - Last Name:DODDEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, CSW
Mailing Address - Street 1:1030 BURLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8444
Mailing Address - Country:US
Mailing Address - Phone:859-436-8472
Mailing Address - Fax:
Practice Address - Street 1:293 BIG EDDY RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8964
Practice Address - Country:US
Practice Address - Phone:859-436-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3577141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical