Healthcare Provider Details

I. General information

NPI: 1821254020
Provider Name (Legal Business Name): MICHELLE FIDELL MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLIE FIDELL MSW,LCSW

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N NEW BALLAS RD SUITE 195
CREVE COEUR MO
63141-6814
US

IV. Provider business mailing address

425 N NEW BALLAS RD SUITE 195
CREVE COEUR MO
63141-6814
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-5666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: