Michelle L Middleton, LICSW;MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61405959 Issued in WA

Practice address

2201 SE Basil CT
Port Orchard, WA 98366-2308

Phone

(360) 519-4072

NPI assigned

Dec 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 3, 2025 through Feb 3, 2027

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.

• Rooted Connections Counseling

  • Clinical Social Worker
  • Port Orchard, WA
  • NPI 1225818370
  NPD Authorized official

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

{
    "created_epoch": "1670284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1497466908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 SE BASIL CT",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662308",
            "telephone_number": "360-519-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 SE BASIL CT",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662308",
            "telephone_number": "360-519-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDLETON",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "LICSW;MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-06",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC60890399",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61405959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Ayn Meyer, M.D.
• Middendorf Chiropractic PS
• David Warren Middendorf, D.C.
• Eric Edward Middendorf, DC
• Joyce K Middendorf, D.C.
• Mile Hill Chiropractic
• Miller Chiropractic, Inc.
• Eric W Miller, DC
• Jennifer Miller, COTA
• Corenna Millet Klimp, L.M.P.

• Clinical Social Worker in Port Orchard, WA
• Providers in Port Orchard, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.