Provider Demographics
NPI:1407309123
Name:MCDONALD, MICHELLE (MS)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:320 SATURN ST N STE A
Mailing Address - Street 2:
Mailing Address - City:COSMOS
Mailing Address - State:MN
Mailing Address - Zip Code:56228-9757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 SATURN ST N
Practice Address - Street 2:
Practice Address - City:COSMOS
Practice Address - State:MN
Practice Address - Zip Code:56228-9757
Practice Address - Country:US
Practice Address - Phone:320-877-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health