Provider Demographics
NPI:1033908801
Name:STAN, MICHELLE SWEENEY (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SWEENEY
Last Name:STAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11638 LEONARDO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9447
Mailing Address - Country:US
Mailing Address - Phone:219-789-5159
Mailing Address - Fax:
Practice Address - Street 1:11638 LEONARDO DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9447
Practice Address - Country:US
Practice Address - Phone:219-789-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004493A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical