Provider Demographics
NPI:1235693656
Name:DEPOWSKI-KNOWLES, REID (LMSW)
Entity type:Individual
Prefix:MRS
First Name:REID
Middle Name:
Last Name:DEPOWSKI-KNOWLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 S HAGADORN RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-481-2133
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD STE 1C2F
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-481-2113
Practice Address - Fax:517-659-5934
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011037481041C0700X
MI6801109185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801103748OtherLARA