Healthcare Provider Details

I. General information

NPI: 1245330307
Provider Name (Legal Business Name): MICHELLE LYNN BINGEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN KUZULKA LCSW

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 S 17TH AVE SUITE 10
WEST BEND WI
53095-3001
US

IV. Provider business mailing address

279 S 17TH AVE SUITE 10
WEST BEND WI
53095-3001
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-8994
  • Fax: 262-306-9317
Mailing address:
  • Phone: 262-306-8994
  • Fax: 262-306-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number646123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: