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General NPI Number Information
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NPI Number | 1154198901
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Entity Type | Individual
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Provider Name | MICHELLE PERCUDANI
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 5455 SHERIDAN RD LOWR LEVEL10
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City | KENOSHA
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State | WI
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Zip | 53140-3734
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Country | US
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Telephone | 262-909-0356
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Fax |
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Provider Business Mailing Address
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Address Line | 6650 MARINER DR UNIT 104
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-3959
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Country | US
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Telephone | 815-901-3773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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