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General NPI Number Information
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NPI Number | 1649992579
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Entity Type | Individual
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Provider Name | MS. MIKELE GRACE MICHIELS-WELDON
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Gender | Female
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 122 W WASHINGTON AVE STE 630
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City | MADISON
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State | WI
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Zip | 53703-2758
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Country | US
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Telephone | 920-750-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 2013 FRAZER PL APT 2
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City | MADISON
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State | WI
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Zip | 53713-1125
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Country | US
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Telephone | 920-750-0171
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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