Provider Demographics
NPI:1861761082
Name:CROWSON, MICHELLE MARIE (LADC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:CROWSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:THEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:722 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2528
Mailing Address - Country:US
Mailing Address - Phone:218-751-3280
Mailing Address - Fax:218-751-3298
Practice Address - Street 1:722 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2528
Practice Address - Country:US
Practice Address - Phone:218-751-3280
Practice Address - Fax:218-751-3298
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)