Provider Demographics
NPI:1861733842
Name:MONERSON, MICHELLE CATHERINE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CATHERINE
Last Name:MONERSON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:CATHRINE
Other - Last Name:MONGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3405
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-453-6267
Practice Address - Street 1:420 E SARNIA ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6365
Practice Address - Country:US
Practice Address - Phone:507-454-4341
Practice Address - Fax:507-453-6267
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical