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General NPI Number Information
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NPI Number | 1649329434
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Entity Type | Individual
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Provider Name | MICHELLE RENAE VETTER PHARMD, MSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 200 WILMOT RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4620
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Country | US
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Telephone | 847-315-2500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35
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City | HUXLEY
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State | IA
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Zip | 50124-0035
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Country | US
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Telephone | 515-745-0581
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Fax | 515-597-2541
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06645
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License Number State | IA
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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 | 34003346A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23523
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License Number State | IA
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