Healthcare Provider Details

I. General information

NPI: 1548978869
Provider Name (Legal Business Name): HEATHER RAE ROBINSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E GRAND RIVER AVE
HOWELL MI
48843-2478
US

IV. Provider business mailing address

2280 E GRAND RIVER AVE
HOWELL MI
48843-8503
US

V. Phone/Fax

Practice location:
  • Phone: 517-404-5500
  • Fax:
Mailing address:
  • Phone: 517-546-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: