MEDICARE: MS. KATE M CRAGWALL L.M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801011390	MI

General Provider Information

NPI Number	:	1033398706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATE M CRAGWALL L.M.S.W.

Provider Business Mailing Address
First Line	:	4469 CASCADE RD SE
Second Line	:	SUITE 4469
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3632
Country	:	US
Telephone Number	:	616-940-3331
Fax Number	:	616-940-1377

Provider Business Practice Location Address
First Line	:	4469 CASCADE RD SE
Second Line	:	SUITE 4469
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3632
Country	:	US
Telephone Number	:	616-940-3331
Fax Number	:	616-940-1377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	01/17/2008

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