Healthcare Provider Details

I. General information

NPI: 1982945101
Provider Name (Legal Business Name): DEANNA F. OMONIYI LMSW, CAADC, ADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 KING HWY STE 120
KALAMAZOO MI
49001-2579
US

IV. Provider business mailing address

834 KING HWY STE 120
KALAMAZOO MI
49001-2579
US

V. Phone/Fax

Practice location:
  • Phone: 269-598-2837
  • Fax: 844-279-3926
Mailing address:
  • Phone: 269-598-2837
  • Fax: 844-279-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: