| NPI | 1770922056 |
|---|---|
| Former Name | MICHELLE MARIE KELLISON/RAUSCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15916-132) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2022-11-30 |