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General NPI Number Information
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NPI Number | 1285858076
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Entity Type | Individual
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Provider Name | MARY J GROGAN ACSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 612 W MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49201-1907
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Country | US
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Telephone | 517-936-7277
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Fax | 734-433-4213
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Provider Business Mailing Address
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Address Line | 18187 N TERRITORIAL RD APT A
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City | CHELSEA
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State | MI
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Zip | 48118-9154
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Country | US
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Telephone | 517-936-7277
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Fax | 734-433-4213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801060097
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License Number State | MI
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