| Doctor Name: | MICHELLE DIANE STOLLER |
| NPI Number: | 1043680622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PLMHP |
| License Number: | 10683 |
| Business Practice Address: | 2608 Old Fair Rd Grand Island, NE - 688035271 |
| Business Phone Number: | 3083825297 |
| Business Fax Number: | 3083825315 |
| Mailing Address: | 2608 Old Fair Rd, GRAND ISLAND |
| State: | NE |
| Postal Code: | 688035271 |
| Phone Number: | 3083825297 |
| Fax Number: | 3083825315 |
| NPI Enumeration Date: | 09/25/2015 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 10683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |