Individual
MICAYLA M SELISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1325 ANGELS PATH, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Mailing address
PO BOX 22040, GREEN BAY, WI 54305-2040
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
132403
WI
1041C0700X
Clinical Social Worker
Primary
11174-123
WI
Other
Enumeration date
04/08/2022
Last updated
09/27/2024
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