Healthcare Provider Details

I. General information

NPI: 1699137349
Provider Name (Legal Business Name): MICHELLE LYNN DELOREY M.S.E. L.P.C. N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MICHELLE LYNN NIEUWENHEIS

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MIDWAY RD
MENASHA WI
54952-1115
US

IV. Provider business mailing address

PO BOX 486 140 W. MAIN STREET SUITE A
WINNECONNE WI
54986
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-2300
  • Fax: 920-720-3719
Mailing address:
  • Phone: 920-582-4000
  • Fax: 888-845-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5718-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5718
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: