Healthcare Provider Details

I. General information

NPI: 1992041339
Provider Name (Legal Business Name): HEATHER KANGAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 PRIMROSE LN
YPSILANTI MI
48197
US

IV. Provider business mailing address

3162 PRIMROSE LN
YPSILANTI MI
48197-3214
US

V. Phone/Fax

Practice location:
  • Phone: 734-883-5523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092655
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: