Provider Demographics
NPI:1861156200
Name:WROBEL, MIKELLE MITZI (SSW)
Entity type:Individual
Prefix:MRS
First Name:MIKELLE
Middle Name:MITZI
Last Name:WROBEL
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3042
Mailing Address - Country:US
Mailing Address - Phone:385-888-0096
Mailing Address - Fax:
Practice Address - Street 1:763 W 700 S
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-1438
Practice Address - Country:US
Practice Address - Phone:801-292-2318
Practice Address - Fax:801-295-2556
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13082475-35031041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT000055266OtherMEDICARE PIN
UT8760003008007Medicaid