Healthcare Provider Details

I. General information

NPI: 1679928352
Provider Name (Legal Business Name): MICHELE JOY FLATAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE JOY FLATAU LICSW

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W SUPERIOR ST STE 511
DULUTH MN
55802-5115
US

IV. Provider business mailing address

302 W SUPERIOR ST STE 511
DULUTH MN
55802-5115
US

V. Phone/Fax

Practice location:
  • Phone: 218-321-1880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20572
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9424-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20572
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: