Individual
MICHELLE C EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
2422 N GRANDVIEW BLVD, WAUKESHA, WI 53188-6105
(262) 549-6600
Mailing address
2422 N GRANDVIEW BLVD, WAUKESHA, WI 53188-6105
(262) 549-6600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10131-130
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
19131-130
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19131-130
DSPS
WI
Enumeration date
01/21/2021
Last updated
01/21/2021
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