Provider Demographics
NPI:1447679725
Name:WRAGGE, MICHELLE (PLADC, PLMHP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WRAGGE
Suffix:
Gender:F
Credentials:PLADC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 W 2ND ST STE 450
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5473
Mailing Address - Country:US
Mailing Address - Phone:308-384-4405
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST STE 450
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5473
Practice Address - Country:US
Practice Address - Phone:308-384-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP1372101YA0400X
NEP10782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470522836Medicaid