Healthcare Provider Details

I. General information

NPI: 1447633193
Provider Name (Legal Business Name): MICHELLE SWENSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JANSEN

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E LONGVIEW DR
APPLETON WI
54911-2167
US

IV. Provider business mailing address

424 E LONGVIEW DR STE A
APPLETON WI
54911-2167
US

V. Phone/Fax

Practice location:
  • Phone: 920-234-9240
  • Fax:
Mailing address:
  • Phone: 920-234-9240
  • Fax: 920-364-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5449-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: