Provider Demographics
NPI:1144845637
Name:VENEGONI-VIGIL, MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VENEGONI-VIGIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:VENEGONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 WHITLOCK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:IL
Mailing Address - Zip Code:62977-1514
Mailing Address - Country:US
Mailing Address - Phone:618-967-1687
Mailing Address - Fax:
Practice Address - Street 1:4505 W DEYOUNG ST STE 203C
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5899
Practice Address - Country:US
Practice Address - Phone:618-283-2222
Practice Address - Fax:844-270-4161
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker