Healthcare Provider Details

I. General information

NPI: 1700877511
Provider Name (Legal Business Name): KATHEEN DELP HIGGINS LMSW, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN J DELP MSW,CGC

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 2000
GRAND RAPIDS MI
49503-2526
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059036
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number7201000185
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: