Provider Demographics
NPI:1215735816
Name:LOEW, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LOEW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2594
Mailing Address - Country:US
Mailing Address - Phone:712-210-3756
Mailing Address - Fax:
Practice Address - Street 1:523 WALKER ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:IA
Practice Address - Zip Code:51579-1260
Practice Address - Country:US
Practice Address - Phone:712-647-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health