Healthcare Provider Details

I. General information

NPI: 1023367018
Provider Name (Legal Business Name): MICHELLE LEIGH CUSHMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LEIGH JOHNSTON M.S.

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SW 4TH ST STE 112
ANKENY IA
50023-2964
US

IV. Provider business mailing address

702 SW 4TH ST STE 112
ANKENY IA
50023-2964
US

V. Phone/Fax

Practice location:
  • Phone: 515-325-4133
  • Fax: 844-799-6001
Mailing address:
  • Phone: 515-325-4133
  • Fax: 844-799-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number001360
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: