Basic Information
| Provider Information | |||||||||
| NPI: | 1235693656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPOWSKI-KNOWLES | ||||||||
| FirstName: | REID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4572 S HAGADORN RD STE 1C | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174812133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4572 S HAGADORN RD STE 1C2F | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174812113 | ||||||||
| FaxNumber: | 5176595934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2019 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6801103748 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801109185 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 6801103748 | 01 | MI | LARA | OTHER |