Healthcare Provider Details

I. General information

NPI: 1639470669
Provider Name (Legal Business Name): MICHELLE OWEN NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 GAMMON PL STE 290
MADISON WI
53719-1075
US

IV. Provider business mailing address

9613 LOST PINE TRL
VERONA WI
53593-8438
US

V. Phone/Fax

Practice location:
  • Phone: 608-285-2974
  • Fax: 608-841-1113
Mailing address:
  • Phone: 608-977-4027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5774-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: