Provider Demographics
NPI:1861910085
Name:NANJI, MICHELLE M (PHD, HSP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:NANJI
Suffix:
Gender:F
Credentials:PHD, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 5TH ST.
Mailing Address - Street 2:STE. 202
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2939
Mailing Address - Country:US
Mailing Address - Phone:319-358-6520
Mailing Address - Fax:319-538-0093
Practice Address - Street 1:1303 5TH ST.
Practice Address - Street 2:STE. 202
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2939
Practice Address - Country:US
Practice Address - Phone:319-358-6520
Practice Address - Fax:319-538-0093
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE567101YM0800X
IA092918103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health