Provider Demographics
NPI:1023102787
Name:MONROE, MICHELE ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNE
Last Name:MONROE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 GREEN ACRES RD
Mailing Address - Street 2:STE 102-288
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1505
Mailing Address - Country:US
Mailing Address - Phone:541-255-8822
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:1450 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1417
Practice Address - Country:US
Practice Address - Phone:541-255-8822
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130521Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER