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NPI Code Detail

MEDICARE: MICHELLE BOURDO

MEDICARE: MICHELLE BOURDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor12634-125WI

General Provider Information

NPI Number : 1174231013
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE BOURDO
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16535 W BLUEMOUND RD STE 200
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-5906
Country : US
Telephone Number : 262-999-3495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2022
Last Update Date : 06/24/2026

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Directions to “ MICHELLE BOURDO ” Practice Location

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