Healthcare Provider Details

I. General information

NPI: 1912876467
Provider Name (Legal Business Name): MORGAN RAE KANIGOWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

IV. Provider business mailing address

1015 LILAC CT NE
GRAND RAPIDS MI
49503-3615
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-6480
  • Fax:
Mailing address:
  • Phone: 248-219-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: