Individual
MRS. MICHELLE R EDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W.
Contact information
Practice address
2701 LARSEN RD STE 216, GREEN BAY, WI 54303-4863
(920) 883-6995
(920) 496-6009
Mailing address
2701 LARSEN RD STE 216, GREEN BAY, WI 54303-4863
(920) 883-6995
(920) 496-6009
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6671-123
WI
1041C0700X
Clinical Social Worker
Primary
6671-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100027601
—
WI
Enumeration date
08/14/2012
Last updated
12/04/2017
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