Provider Demographics
NPI:1649329434
Name:VETTER, MICHELLE RENAE (PHARMD, MSW, LISW)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENAE
Last Name:VETTER
Suffix:
Gender:F
Credentials:PHARMD, MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-0035
Mailing Address - Country:US
Mailing Address - Phone:515-745-0581
Mailing Address - Fax:515-597-2541
Practice Address - Street 1:200 WILMOT RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4620
Practice Address - Country:US
Practice Address - Phone:847-315-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066451041C0700X
IN34003346A1041C0700X
IA23523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5766812OtherEIN