Michelle J Damm, LPC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4423-226 Issued in WI

Practice address

418 E Wisconsin Ave
Oconomowoc, WI 53066-3040

Phone

(414) 429-6403

NPI assigned

Aug 2, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Michelle J Roth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creative Healing Arts & Counseling LLC

  • Social Worker
  • Oconomowoc, WI
  • NPI 1871986828

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1033764469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 E LAKE ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511738",
            "telephone_number": "920-366-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 E WISCONSIN AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663040",
            "telephone_number": "414-429-6403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMM",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "credential": "LPC-IT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4423-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "ROTH",
            "middle_name": "J",
            "credential": "LPC-IT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly L. Cridelich, OT
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• Michael Loyal Cummens, M.D.
• Ginny Dacquisto, RD, CD
• Brian Dalbke
• Siera Daniels, NCC, LPC-IT, MS
• Margaret Anne Dare, RPH
• David a Byrne Psy D LTD
• David G. Kamper, M.D. S.C.
• Margaret J Davis, L .AC.

• Professional Counselor in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.