Provider Demographics
NPI:1447633193
Name:SWENSON, MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 PARK PL
Mailing Address - Street 2:400
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8232
Mailing Address - Country:US
Mailing Address - Phone:920-733-8119
Mailing Address - Fax:920-733-8190
Practice Address - Street 1:17 PARK PL
Practice Address - Street 2:400
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8232
Practice Address - Country:US
Practice Address - Phone:920-209-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5449-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health