Provider Demographics
NPI:1285710863
Name:WINCELL, MICHELLE (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WINCELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13024 89TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9513
Mailing Address - Country:US
Mailing Address - Phone:763-753-7310
Mailing Address - Fax:763-753-6529
Practice Address - Street 1:22426 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-9670
Practice Address - Country:US
Practice Address - Phone:763-753-7310
Practice Address - Fax:763-753-6529
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW122491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical