Provider Demographics
NPI:1295958767
Name:MACGREGOR, IAN KEITH (ACSW LMSW)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:KEITH
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:ACSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 TOWNER BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5034
Mailing Address - Country:US
Mailing Address - Phone:734-971-1996
Mailing Address - Fax:743-971-1999
Practice Address - Street 1:2461 TOWNER BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5034
Practice Address - Country:US
Practice Address - Phone:734-971-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68014046856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker