Provider Demographics
NPI:1538767108
Name:FENELON, MICHELLE DENISE (LISW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:FENELON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 334TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276-7509
Mailing Address - Country:US
Mailing Address - Phone:515-438-3481
Mailing Address - Fax:
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-3481
Practice Address - Fax:515-438-3489
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA052841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical