Healthcare Provider Details

I. General information

NPI: 1548663438
Provider Name (Legal Business Name): HEIDI MCGRAW LLBSW, QIDP, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 COBB ST
CADILLAC MI
49601-2540
US

IV. Provider business mailing address

5619 N JACK RD
MIDLAND MI
48642-8436
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-3463
  • Fax:
Mailing address:
  • Phone: 989-859-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802088273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: