Individual
MICHELLE M. RUNNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 654-1004
(262) 654-6960
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 654-1004
(262) 654-6960
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12685
WI
101YP2500X
Professional Counselor
Primary
2989-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39752900
—
WI
Enumeration date
05/23/2007
Last updated
06/30/2008
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