Provider Demographics
NPI:1114391513
Name:AUSTIN, MICHELLE (LICSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5305
Mailing Address - Country:US
Mailing Address - Phone:507-474-1985
Mailing Address - Fax:507-474-0345
Practice Address - Street 1:2104 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-6607
Practice Address - Country:US
Practice Address - Phone:952-649-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN178001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical