Michelle A Poore, LIC SW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

07772 Issued in MN

Practice address

8675 Valley Creek Rd
Woodbury, MN 55125-2337

Phone

(651) 501-3000

Fax

(651) 501-3500

NPI assigned

Apr 6, 2006

Last updated

Dec 15, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Michelle Poore Griggs Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481760000000",
    "number": "1598727109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MR 10809",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-4813",
            "fax_number": "612-262-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8675 VALLEY CREEK RD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252337",
            "telephone_number": "651-501-3000",
            "fax_number": "651-501-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POORE",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "LIC SW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2016-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "07772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228057400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "GRIGGS",
            "middle_name": "POORE",
            "prefix": "MRS.",
            "credential": "LIC SW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Scott William Poeschel, DC
• Kimberly A Poitra, LICSW
• Kristina Pokharel
• Anthony John Polcari, M.D.
• David Pontius, PA-C
• Denton Wilson Porter Jr., PHARMD
• Jason Michael Porter, LPCC
• Marquel Elaine Porter
• Anne Poulsen, M.D.
• Powell Family Dentistry Inc.

• Clinical Social Worker in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; 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.