Provider Demographics
NPI:1649992579
Name:MICHIELS-WELDON, MIKELE GRACE
Entity type:Individual
Prefix:MS
First Name:MIKELE
Middle Name:GRACE
Last Name:MICHIELS-WELDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MICHIELS-WELDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2013 FRAZER PL APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1125
Mailing Address - Country:US
Mailing Address - Phone:920-750-0171
Mailing Address - Fax:
Practice Address - Street 1:122 W WASHINGTON AVE STE 630
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2758
Practice Address - Country:US
Practice Address - Phone:920-750-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health