Provider Demographics
NPI:1699374017
Name:LOWE, RILEY MICHELLE
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:MICHELLE
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31478 INDUSTRIAL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1840
Mailing Address - Country:US
Mailing Address - Phone:734-245-2500
Mailing Address - Fax:
Practice Address - Street 1:31478 INDUSTRIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1840
Practice Address - Country:US
Practice Address - Phone:734-245-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI68511140881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program