Provider Demographics
NPI:1720237407
Name:GROGAN, HEIDI ELISABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ELISABETH
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:ELISABETH
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1400 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2651
Mailing Address - Country:US
Mailing Address - Phone:734-656-0130
Mailing Address - Fax:734-656-9845
Practice Address - Street 1:14500 N SHELDON RD # 160A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2597
Practice Address - Country:US
Practice Address - Phone:734-656-0130
Practice Address - Fax:734-656-9845
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801091158OtherMASTER'S SOCIAL WORKER CLINICAL LICENSE