Provider Demographics
NPI:1144684440
Name:WONG, MICHELLE (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5367
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0367
Mailing Address - Country:US
Mailing Address - Phone:808-500-6352
Mailing Address - Fax:808-470-5372
Practice Address - Street 1:492 E 13TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4250
Practice Address - Country:US
Practice Address - Phone:808-500-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL117881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical