Provider Demographics
NPI:1881883767
Name:DOWNEY, MICHELLE ANN
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:KLINKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC, LPC
Mailing Address - Street 1:712 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2924
Mailing Address - Country:US
Mailing Address - Phone:920-248-2640
Mailing Address - Fax:
Practice Address - Street 1:1505 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3276
Practice Address - Country:US
Practice Address - Phone:812-522-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15348131101Y00000X
KY345975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15348131OtherDEPT OF REGULATION LIC
WI39178400Medicaid