Healthcare Provider Details

I. General information

NPI: 1396624193
Provider Name (Legal Business Name): EMILY GRACE MCCLOSKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35300 NANKIN BLVD STE 601
WESTLAND MI
48185-7222
US

IV. Provider business mailing address

1658 BROADSTONE RD
GROSSE POINTE WOODS MI
48236-1949
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-1842
  • Fax:
Mailing address:
  • Phone: 313-236-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: