Basic Information
| Provider Information | |||||||||
| NPI: | 1801169917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSED, CSAC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 TOWER AVE | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153921955 | ||||||||
| FaxNumber: | 7153921935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N 34TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SUPERIOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548804477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153928216 | ||||||||
| FaxNumber: | 7153926055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1651-132 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 5453-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.