Healthcare Provider Details

I. General information

NPI: 1811278054
Provider Name (Legal Business Name): MICHELLE GLORIA PARISOT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 10/27/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

IV. Provider business mailing address

1337 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2712
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax:
Mailing address:
  • Phone: 414-897-5511
  • Fax: 414-385-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3538-57
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3538-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: