MEDICARE: MICHELLE WINCELL

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
1	1041C0700X	Clinical Social Worker	12249	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750589925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE WINCELL

Provider Business Mailing Address
First Line	:	13024 89TH AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-9513
Country	:	US
Telephone Number	:	763-257-2348
Fax Number	:	612-722-1983

Provider Business Practice Location Address
First Line	:	5009 EXCELSIOR BLVD STE 130
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3049
Country	:	US
Telephone Number	:	763-257-2348
Fax Number	:	612-722-1983

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. MICHELLE LYN WINCELL
Credential	:	LICSW
Telephone Number	:	763-257-2348

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	08/12/2008

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Directions to “MICHELLE WINCELL ” Practice Location

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