Provider Demographics
NPI:1588169551
Name:SMITH, MICHELLE SVEIVEN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SVEIVEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:SVEIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7064 W POINT DOUGLAS RD S STE 201
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-2691
Mailing Address - Country:US
Mailing Address - Phone:651-458-5224
Mailing Address - Fax:651-458-5310
Practice Address - Street 1:7064 W POINT DOUGLAS RD S STE 201
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-2691
Practice Address - Country:US
Practice Address - Phone:651-458-5224
Practice Address - Fax:651-458-5310
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical