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General NPI Number Information
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NPI Number | 1285981779
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Entity Type | Individual
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Provider Name | MICHELLE R EDDY M.S.W., L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 2701 LARSEN RD STE 216
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City | GREEN BAY
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State | WI
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Zip | 54303-4863
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Country | US
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Telephone | 920-883-6995
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Fax | 920-496-6009
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Provider Business Mailing Address
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Address Line | 2701 LARSEN RD STE 216
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City | GREEN BAY
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State | WI
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Zip | 54303-4863
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Country | US
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Telephone | 920-883-6995
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Fax | 920-496-6009
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6671-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6671-123
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License Number State | WI
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