Healthcare Provider Details

I. General information

NPI: 1760017644
Provider Name (Legal Business Name): HEATHER KANGAS MSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SALEM CT
ANN ARBOR MI
48104-5266
US

IV. Provider business mailing address

6 SALEM CT
ANN ARBOR MI
48104-5266
US

V. Phone/Fax

Practice location:
  • Phone: 734-883-5523
  • Fax:
Mailing address:
  • Phone: 734-883-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER KANGAS
Title or Position: OWNER
Credential: LMSW
Phone: 734-883-5523