Active NPI
Michelle Marie Dubois, LICSW
- Clinical Social Worker
- Minnetonka, MN
National Provider Identifier
1740505593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17284
- Practice address
- 12601 Ridgedale Dr
Minnetonka, MN 55305-1908 - Phone
- (612) 296-7495
- NPI assigned
- Apr 5, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 17284 | MN | Primary |
Addresses
Primary practice location
12601 Ridgedale Dr
Minnetonka, MN 55305-1908
Mailing address
2434 Blaisdell Ave
#3
Minneapolis, MN 55404-3381
Phone (612) 306-2890
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17284 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270425600000",
"number": "1740505593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2434 BLAISDELL AVE",
"address_2": "#3",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554043381",
"telephone_number": "612-306-2890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12601 RIDGEDALE DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051908",
"telephone_number": "612-296-7495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOIS",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-05",
"last_updated": "2010-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "17284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.