Healthcare Provider Details

I. General information

NPI: 1710137963
Provider Name (Legal Business Name): MICHELLE LYNN THOEN PSY.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. MICHELLE LYNN THOEN

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N CASCADE ST THIRD FLOOR
OSCEOLA WI
54020
US

IV. Provider business mailing address

PO BOX 246
OSCEOLA WI
54020-0246
US

V. Phone/Fax

Practice location:
  • Phone: 612-554-8914
  • Fax: 715-755-2669
Mailing address:
  • Phone: 612-554-8914
  • Fax: 715-417-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number301177
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3989-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: