Provider Demographics
NPI:1952953937
Name:BLUE, MICHELLE (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 MEIJER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-3122
Mailing Address - Country:US
Mailing Address - Phone:419-690-5086
Mailing Address - Fax:419-671-8026
Practice Address - Street 1:3335 MEIJER DR STE 150
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3122
Practice Address - Country:US
Practice Address - Phone:419-690-5086
Practice Address - Fax:419-671-8026
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHI.21028701041C0700X
OHS.1802309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker