Provider Demographics
NPI:1023994043
Name:CLABAUGH, MICHAEL TODD (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:CLABAUGH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 PINE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-9493
Mailing Address - Country:US
Mailing Address - Phone:218-428-1175
Mailing Address - Fax:218-216-1452
Practice Address - Street 1:306 W SUPERIOR ST STE 1000
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1818
Practice Address - Country:US
Practice Address - Phone:218-481-7660
Practice Address - Fax:218-216-1452
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical