Healthcare Provider Details

I. General information

NPI: 1407487879
Provider Name (Legal Business Name): MICHELLE FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MINNESOTA DR STE 450
BLOOMINGTON MN
55435-5214
US

IV. Provider business mailing address

9115 OLD CEDAR AVE S APT 400
BLOOMINGTON MN
55425-2383
US

V. Phone/Fax

Practice location:
  • Phone: 612-250-7129
  • Fax:
Mailing address:
  • Phone: 612-517-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28616
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: