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General NPI Number Information
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NPI Number | 1205661428
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Entity Type | Individual
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Provider Name | MICHELLE ANNE MUCKERHEIDE ED.S.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 1331 N BLUE RD
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City | GREENFIELD
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State | IN
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Zip | 46140-6512
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Country | US
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Telephone | 317-462-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 110 W NORTH ST
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City | GREENFIELD
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State | IN
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Zip | 46140-2172
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Country | US
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Telephone | 317-498-1384
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1100298
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License Number State | IN
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