Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3181 | WI |
Y | 103T00000X | Psychologist | 3181 | WI |
NPI | 1013317940 |
---|---|
Provider Name | Michelle Mcelligott |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2014 |
Last Update Date | 28/08/2014 |