Healthcare Provider Details

I. General information

NPI: 1235162132
Provider Name (Legal Business Name): MICHAEL EDWARD BAGGALEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BURDICK EXPY E STE 101
MINOT ND
58701-5006
US

IV. Provider business mailing address

701 19TH AVE SE APT 11
MINOT ND
58701-6733
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-0464
  • Fax:
Mailing address:
  • Phone: 801-349-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5139730-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6240
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: