Stephanie Larsen Mickelsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-22407 Issued in AZ

Practice address

17100 N 67TH Ave Ste 400
Glendale, AZ 85308-3698

Phone

(480) 485-5919

NPI assigned

Sep 29, 2020

Last updated

Aug 3, 2024By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Surge Points LLC

  • Counselor
  • Glendale, AZ
  • NPI 1619428356
  NPD (past)

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1508473042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE STE 400",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE STE 400",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083698",
            "telephone_number": "480-485-5919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSEN",
        "first_name": "STEPHANIE",
        "middle_name": "LARSEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-22407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael L Kravetz, MD, PLC
• Michael L. Sweeney,MSW,P.C.
• Cecil Frances Michael Jr., MD
• Rebecca Jeannine Michael, FNP-C
• Glenn Micheels, D.C.
• Jazmin Denise Mickens, RD
• Lexi Lynn Mickey, AGDNP-C
• Donald Ray Middleton, DO
• Midwestern University
• Midwestern University (Midwestern University Dental Institute)

• Clinical Social Worker in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; 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.