Provider Demographics
NPI:1740516798
Name:TROTTER-MATHISON, MICHELLE JUDITH (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JUDITH
Last Name:TROTTER-MATHISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CLEVELAND AVE S STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1319
Mailing Address - Country:US
Mailing Address - Phone:612-396-6901
Mailing Address - Fax:
Practice Address - Street 1:690 CLEVELAND AVE S STE 202
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1319
Practice Address - Country:US
Practice Address - Phone:612-396-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5343103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling