Provider Demographics
NPI:1023684677
Name:OLUND YOUNGBERG, MICHELLE OLIVIA (LGSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:OLIVIA
Last Name:OLUND YOUNGBERG
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8040
Practice Address - Street 1:1306 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8040
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical